A Case of Postpartum Preeclampsia With an Unusual Presentation

Preeclampsia is a hypertensive disorder of pregnancy that usually presents with elevated blood pressure. It may also occur in the postpartum period with atypical features, which can complicate timely recognition and adequate treatment. We report a case of a 33-year-old female patient who presented five days postpartum with chest tightness and shortness of breath. Initial findings were atypical for preeclampsia. She was severely bradycardic and normotensive, though hypoxic and tachypneic. Workup excluded postpartum cardiomyopathy and pulmonary embolism (PE), but revealed small bilateral pleural effusions. Within three hours, her blood pressure rose to 160/90 mmHg. Given the rapid onset of severe hypertension combined with laboratory evidence of multisystem organ involvement, including mildly elevated liver enzymes, proteinuria, and pleural effusions, she was diagnosed with preeclampsia with severe features. Management included oxygen and antihypertensive therapy with hydralazine. She was safely discharged two days later. This case is notable because the patient presented with bradycardia and normotension, which are uncommon findings in preeclampsia. The subsequent rise in blood pressure, combined with pleural effusions, supported the diagnosis once other cardiopulmonary causes were excluded. Careful evaluation, timely treatment, and appropriate monitoring led to a favorable outcome. This highlights the importance of considering preeclampsia in postpartum patients with atypical presentations.