Preeclampsia Presenting in a Postpartum Woman without Proteinuria: Is that Possible?

BACKGROUND: The diagnosis of preeclampsia has traditionally been defined as new-onset hypertension with proteinuria in a peripartum woman. This case report aims to share an update in obstetrics and gynecology that allows a diagnosis of preeclampsia to be made in the absence of proteinuria.
CASE REPORT: We describe the case of a 22-year-old African-American woman who presented to our institution 5 days after a cesarean section with worsening dyspnea and new-onset hypertension. Pre-eclampsia was suspected but was ruled out after a urinalysis was negative for proteinuria. Computed tomography angiography (CTA) showed bilateral airspace opacity and pleural effusions but a 2D echocardiogram showed a normal ejection fraction. She was suspected to have resolving post-partum cardiomyopathy and was treated with diuresis and anti-hypertensives. The American College of Obstetrics and Gynecology (ACOG) guidelines specify a diagnosis of preeclampsia can be made without proteinuria if there is new-onset hypertension with end-organ damage. Thus, our patient may have benefited from magnesium sulfate therapy to prevent risk of seizures in adjunct to the above treatment.
CONCLUSIONS: Preeclampsia can be diagnosed without the presence of proteinuria. With constantly evolving specialty guidelines, internal medicine physicians may not be able to stay abreast of the latest developments. The present case highlights the importance of timely consultant involvement in the peri-/post-partum period.

Keywords: Postpartum Period, Pre-Eclampsia, Pulmonary Edema