Liver transplantation for acute Budd-Chiari syndrome in identical twin sisters with Factor V leiden mutation.
BACKGROUND
Budd-Chiari syndrome (BCS) is uncommon in the children. The cause of BCS comprises several diseases leading to thrombophilia. Activated protein C resistance as a result of a single gene mutation in factor V, the so called factor V Leiden (FVL), is the most common cause of thrombophilia.


METHODS
We report a simultaneous occurrence of BCS in identical twin sisters of 13 years of age with heterozygous FVL mutation.


RESULTS
One sister presented with acute BCS leading to fulminant hepatic failure. She underwent liver transplantation with subsequent normalization of activated protein C resistance. The other twin sister, who was diagnosed with extensive thromboses of the inferior vena cava, portal vein, and hepatic veins, was successfully managed by aggressive chemical and mechanical thrombolysis followed by therapeutic anticoagulation. Genomic DNA studies confirmed heterozygosity of FVL mutation in the sisters' father and older brother.


CONCLUSIONS
The exact cause of the BCS in children should be thoroughly and rapidly investigated, and, if necessary, immediate family members should also be tested for genetic defects in factor V or concomitant thrombophilia.
Nezakatgoo
Nosratollah
N
Department of Surgery, University of Tennessee, Memphis, Tennessee 38163-2116, USA.
Shokouh-Amiri
M Hosein
MH
Gaber
A Osama
AO
Grewal
Hani P
HP
Vera
Santiago R
SR
Chamsuddin
Abbas A
AA
Eshun
John K
JK
Jeng
M
M
D000293:Adolescent; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging / Q000235:genetics* / Q000601:surgery*; D005165:Factor V / Q000235:genetics*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D016031:Liver Transplantation / Q000276:immunology*; D014430:Twins, Monozygotic; D014463:Ultrasonography
C095381:factor V Leiden; D005165:Factor V