Journal of Education and Teaching in Emergency Medicine

The incidence of syncope in the setting of ruptured ectopic pregnancy can vary widely; however, data specifically focusing on syncope as the primary presenting symptom without accompanying abdominal pain or vaginal bleeding are scarce.^1,2 Our 23-year-old female patient, who is post-liver transplant and currently on immunosuppressive therapy, experienced syncope without significant pain or bleeding and presented to the ED with stable vital signs. Initial investigations revealed mild left lower quadrant tenderness, a serum beta-hCG of 95 mIU/mL, and moderate free pelvic fluid with a 28 mm left ovarian “cyst” on transvaginal ultrasound. These findings raised concerns for a ruptured ectopic pregnancy. Diagnostic laparoscopy, however, ultimately revealed a ruptured ovarian hemorrhagic cyst. Subsequent negative urine beta-hCG tests confirmed the initial serum beta-hCG as a false positive likely due to heterophile antibody interference, which is common in immunosuppressed patients. This case represents a rare mimic of a ruptured ectopic pregnancy which can occur in post-transplant patients and a nuanced interpretation of clinical workup.