Nadir ve Özel Bir Komplikasyon: Over Hiperstimülasyon Sendromuna Bağlı Plevral Efüzyon

Abstract

Ovarian Hiperstimülasyon Sendromu (OHSS); iatrojenik olabildiği gibi overlerin uyarılması için verilen tedaviye karşı aşırı bir yanıt ve hassasiyet olarak tanımlanmaktadır. Çok farklı klinik ve laboratuvar bulgularıyla görülebilmektedir. Overlerin stimülasyonun bir sonucu olarak, serum intravasküler alandan üçüncü boşluğa geçiş yaparak; assit ve plevral efüzyon gibi komplikasyonlara yol açabilir. Bu yazıda ovulasyon indüksiyonu tedavisi uygulanan, ve takiplerinde plevral mayi tespit edilen iki olgu literatür eşliğinde sunuldu. Assite parasentez ile yapılan müdahale sonrasında plevral mayini geriledği , hastanın kliniğinin düzeldiği görülmüştür. Yardımcı üreme tekniklerinin gün geçtikçe daha yaygın kullanımıyla OHSS daha sık görülebilir. Bu sebeple Plevral efüzyonun nadir nedenlerinden biri olan OHSS’yi olgular eşliğinde tartışmayı, uygun tedavi ve takip stratejilerin ilk aşamada belirlenmesinin önemini hatırlatmak istedik.

Keywords

• assit
• over hiperstimülasyon sendromu
• plevral efüzyon

A Rare and Unique Complication: Pleural Effusıon Associated With Ovarian Hyperstimulation Syndrome

Abstract

Ovarian Hyperstimulation Syndrome (OHSS) is defined as an excessive response and hypersensitivity to the treatment administered to stimulate the ovaries, which can also occur iatrogenically. It can present a wide range of clinical and laboratory findings. As a result of ovarian stimulation, serum fluid can shift from the intravascular compartment to the third space, leading to complications such as ascites and pleural effusion. This article presents two cases of patients who underwent ovulation induction therapy and were found to have pleural effusion during follow-up, along with a review of the literature. Following an intervention with paracentesis to manage ascites, regression of the pleural effusion and improvement in the patients' clinical condition were observed. With the increasing use of assisted reproductive techniques, OHSS may be encountered more frequently. Therefore, we aim to discuss OHSS, a rare cause of pleural effusion, through these cases and emphasize the importance of determining appropriate treatment and follow-up strategies at the initial stage.

Keywords

• ascites
• ovarian hyperstimulation syndrome
• pleural effusion

References

1. Busso C, Soares S, Pellicer A. Pathogenesis, clinical manifestations, and diagnosis of ovarian hyperstimulation syndrome. In: Connor RF, editor. UpToDate. Waltham (MA): Wolters Kluwer; 2024. (https:// www.uptodate.com/contents/pathogenesis- clinical-manifestations-and-diagnosisof- ovarian-hyperstimulation-syndrome) Erişim Tarihi: 08.05.2025.
2. Taylor H, Pal L, Seli E. Speroff's Clinical Gynecologic Endocrinology and Infertility. 9th ed. Philadelphia, Pennsylvania, USA: Philadelphia Wolter Kluwer; 2020; 1293.
3. American Society for Reproductive Medicine. Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline. Fertility Sterility. 2024;121(2): 230–45. https://doi.org/10.1016/j.fertnstert. 2023.11.013.
4. The management of ovarian hyperstimulation syndrome. London, Green-top Guideline No. 5, 2016 (https://www.rcog.org.uk/ media/or1jqxbf/gtg_5_ohss.pdf ). (Erişim Tarihi:28.01.2025).
5. Sun B, Ma Y, Li L, et al. Factors associated with ovarian hyperstimulation syndrome (OHSS) severity in women with polycystic ovary syndrome undergoing IVF/ICSI. Front Endocrinol. 2021;11:615957. https:// doi.org/10.3389/fendo.2020.615957.
6. McClure N, Healy DL, Rogers PAW, et al. Vascular endothelial growth factor as capillary permeability agent in ovarian hyperstimulation syndrome. Lancet. 1994;344:235-236.
7. Munguti J, Mutua V, Cheruiyot I,et al. Tuberculous polyserositis in endemicareas with an emphasis on empiric therapy: A case report. Med. Case Rep. Study Protoc. 2022; 3(4): e0221.https://journals. lww.com/mdcases/fulltext/2022/04000/ tuberculous_polyserositis_in_endemic_areas_ with_an.3.aspx#:~:text=10.1097/ MD9.0000000000000221.
8. Timmons D, Montrief T, Koyfman A, et al. Ovarian hyperstimulation syndrome: A review for emergency clinicians. Am J Emerg Med. 2019;37:1577-84. https://doi. org/10.1016/j.ajem.2019.05.018.

9. Leathersich S, Roche C, Hart R. Minimising OHSS in women with PCOS. Front. Endocrinol. 2025;16:1507857. https://doi. org/10.3389/fendo.2025.1507857.
10. Ma T, Niu Y, Wei B, et al. Moderate-to-severe ovarian hyperstimulation syndrome: A retrospective multivariate logistic regression analysis in Chinese patients. Adv Clin Exp Med. 2020;29(1):85-90. https://doi. org/10.17219/acem/92916.
11. Liu M, Xie S, Zhou J. Use of animal models for the imaging and quantification of angiogenesis. Exp Anim. 2018; 67(1):1–6. https://doi.org/10.1538/expanim.17-0054.
12. Aldawood AS, Felemban AA. Isolated unilateral pleural effusion as the only manifestation of the ovarian hyperstimulation syndrome. Saudi Med J 2003;24(12):1397–99.
13. Vidal A, Wachter C, Kohl Schwartz A, et al. A rare presentation of isolated right-sided pleural effusion in the context of ovarian hyperstimulation syndrome: A case report. Case Rep Womens Health. 2021;32:e00347. 10.1016/j.crwh.2021.e00347.https://doi. org/10.1016/j.crwh.2021.e00347.
14. Blumenfeld Z. The Ovarian hyperstimulation syndrome. Vitam Horm. 2018; 107:423-51. https://doi.org/10.1016/ bs.vh.2018.01.018
15. Palomba S, Costanzi F, Nelson SM, et al. Interventions to prevent or reduce the incidence and severity of ovarian hyperstimulation syndrome: a systematic umbrella review of the best clinical evidence. Reprod Biol Endocrinol. 2023;21(1): 67. https:// doi.org/10.1186/s12958-023-01113-6.