Clinical manifestation and management in a resource-limited setting of Ballantyne syndrome (Mirror syndrome) associated with preeclampsia, a case report.

Introduction and importance: Ballantyne syndrome, also known as triple edema or maternal mirror syndrome, is an extremely rare clinical condition characterized by maternal edema, placentomegaly, and fetal hydrops. Its rarity and overlapping symptoms often lead to misdiagnosis, particularly in resource-limited settings. Management is primarily etiological and focuses on addressing the underlying cause. This case highlights the challenges encountered in managing Ballantyne syndrome associated with preeclampsia in a resource-limited setting. Case presentation: A 21-year-old woman, blood group AB Rh-positive, was hospitalized at 24 weeks of gestation with generalized edema and absent fetal movements. She had limited antenatal care, with only one prenatal visit and two ultrasounds, both showing placentomegaly that obscured optimal visualization of fetal structures. Clinical assessment confirmed severe preeclampsia complicated by fetal-maternal hydrops. Given the maternal risks and the poor fetal prognosis, pregnancy termination was performed. Induction of labor resulted in the delivery of a hydropic fetus, who succumbed shortly after birth. The patient recovered without complications following symptomatic management of preeclampsia. Clinical discussion: Ballantyne syndrome, although rare, poses a significant maternal risk and requires prompt recognition and intervention. In this case, severe preeclampsia and fetal hydrops contributed to the worsening maternal condition, necessitating urgent pregnancy termination to prevent further complications. The patient's limited access to antenatal care may have delayed diagnosis, underscoring the importance of early screening and multidisciplinary management in high-risk pregnancies. Conclusion: This case highlights the critical need for early diagnosis and timely intervention in managing Ballantyne syndrome and preeclampsia, particularly in resource-limited settings. Strengthening antenatal care, comprehensive patient counseling, and evidence-based management is essential to improving maternal and perinatal outcomes in such complex cases.