MOSCHCOWITZ SYNDROME IN TWIN PREGNANT WOMEN AFTER OOCYTES DONOR CYCLES: A CASE REPORT

INTRODUCTION Oocytes donation program represents an important strategy for women of advanced age with reduced ovarian reserve in order to achieve a pregnancy. The excellent success rate makes this procedure more and more spread in IVF centers and it was estimated that it constitutes currently the 4.5% of all IVF/ICSI cycles. Nonetheless, several concerns are raising regarding pregnancy outcome after IVF/donor cycles. There is evidence that oocytes donation is independently associated with pregnancy-induced hypertensive disorders. This risk seems even higher in twin pregnancies in which higher placental mass exacerbates both immunologic factors and endothelial dysfunctions, which represent the most important pathogenetic triggers. METHODS We reported a case of a 45 years old women who underwent egg donation program. While the first pregnancy was carried out successfully without complication, the second twin pregnancy achieved from the same donor was characterized by the development of severe hypertensive disorders at 34th week of pregnancy, which was, in the first step, diagnosed as HEELP syndrome. After emergency cesarean section, the women was transferred to intensive care unit. After deep investigations, the definitive diagnosis was Moschcowitz syndrome. Thrombotic thrombocytopenic purpura (TTP) is a rare blood disorder characterized by microangiopathic hemolytic anemia, thrombocytopenic purpura, neurologic abnormalities, fever, and renal disease. The patient reported a subacute onset of symptoms related to anemia, thrombocytopenia and neurologic dysfunction. Neurologic manifestations included alteration in mental status, seizures, hemiplegia, paresthesias, visual disturbance and aphasia. RESULTS Immunological analysis revealed a lower ratio of activated/regulatory T cells suggesting an inadequate counteractive response, which could explains the development of Moschcowitz syndrome in this woman. The woman was subsequently discharged without relevant sequalae. CONCLUSIONS This case suggests how even in pregnancies achieved with oocytes donation programs, Moschcowitz syndrome could develop. In addition, as reported by several cases, this syndrome could be easily mismatched with preeclampsia and its severe expression (HELLP syndrome). As reported by other studies, this case supports the hypothesis that in pregnancy achieved with oocytes donation hypertensive disorders and Moschcowitz syndrome could be part of a spectrum of the same illness with shared underlying endothelial dysfunction but more studies are necessary to confirm the supposed link.