Critical COVID-19 in a pregnant patient who presented in starvation ketoacidosis with a background history of acrorenal syndrome

BMJ Case Rep. 2021 Nov 2;14(11):e244117. doi: 10.1136/bcr-2021-244117.


A primiparous woman in her late 30s at 28+1 weeks' gestation presented with a 3-day history of abdominal pain, loss of appetite, nausea and vomiting and was diagnosed with starvation ketoacidosis. A routine admission swab returned positive for COVID-19. She had been diagnosed with acrorenal syndrome from birth. Three days post admission, she deteriorated rapidly into respiratory failure requiring intubation and ventilation. She was treated with dexamethasone, prophylactic enoxaparin, a course of piperacillin/tazobactam followed by meropenem and fluconazole and 8 cycles of proning. An emergency caesarean section was performed on day 12 of hospital admission at 29+5 weeks' gestation to improve maternal oxygenation and ventilation. The baby had deformities consistent with acrorenal syndrome but no evidence of COVID-19. She spent 23 days in the intensive care unit. Our case describes an unusual presentation of COVID-19, the challenges in managing critically ill pregnant patients along with a rare background history of acrorenal syndrome.

Keywords: COVID-19; genetics; intensive care; obstetrics and gynaecology; pregnancy.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • COVID-19* / complications
  • Cesarean Section
  • Female
  • Fingers / abnormalities
  • Hand Deformities, Congenital
  • Humans
  • Ketosis*
  • Kidney / abnormalities
  • Pregnancy

Supplementary concepts

  • Acrorenal Syndrome