Ectopic Pregnancy with Unusually High beta-HCG

Purpose (a): Ectopic pregnancy is a potentially life-threatening emergency and is usually diagnosed using a combination of clinical symptoms, biochemical markers, and ultrasound studies. However, atypical cases will often present without the classic triad of abdominal pain, amenorrhea, and vaginal spotting. Laboratory and ultrasound studies can also be non-conclusive. Such atypical presentation of ectopic pregnancy is illustrated in this case report. Methods (b): A 32-year-old female, gravida 4, para 2, abortus 1, presented to the obstetrics department with a chief complaint of vaginal bleeding daily for the past two months. She was diagnosed with an ectopic pregnancy, but had an unusual presentation. Management, outcome, literature review, as well as educational point are discussed. Results (c): We report the case of an atypical ectopic pregnancy with initial workup more consistent with an adnexal mass and possible germ cell tumor. The patient denied any lower abdominal pain, had serial beta-hCG levels approaching 60,000 mIU/mL, and a mass of unknown etiology was found on ultrasound. This mass was later discovered to be an intact fetus upon laparoscopy. Conclusions (d): This case illustrates the importance of recognizing ectopic pregnancy in the absence of hemoperitoneum, abdominal pain, confirmatory laboratory or ultrasound studies. Even with extremely high beta-hCG levels, keeping the differential of ectopic pregnancy in mind is crucial and can save the life of the mother.