Reversion of severe hepatopulmonary syndrome in a non cirrhotic patient after corticosteroid treatment for granulomatous hepatitis: a case report and review of the literature.
Hepatopulmonary syndrome (HPS) is defined as a clinical triad including liver disease, abnormal pulmonary gas exchange and evidence of intrapulmonary vascular dilatations. We report a 61-year-old male presented with fatigue, long-lasting fever, loss of weight, signs of portal hypertension, hepatosplenomegaly, cholestasis and progressive dyspnoea over the last year. Clinical, laboratory and histological findings confirmed the diagnosis of granulomatous hepatitis. HPS due to hepatic granuloma-induced portal hypertension was proved to be the cause of severe hypoxemia of the patient as confirmed by contrast-enhanced echocardiography. Reversion of HPS after corticosteroid therapy was confirmed by a new contrast-enhanced echocardiography along with the normalization of cholestatic enzymes and improvement of the patient's conditions. This is the first case of complete reversion of HPS in a non-cirrhotic patient with hepatic granuloma, indicating that intrapulmonary shunt in liver diseases is a functional phenomenon and HPS can be developed even in miscellaneous liver involvement as in this case.
Department of Medicine, Academic Liver Unit, Medical School, University of Thessaly, Papakiriazi 22 str, 41222 Larissa, Greece.
Nikolaos
N
Tzovaras
Aggelos
A
Stefos
Sarah P
SP
Georgiadou
Nikolaos
N
Gatselis
Georgia
G
Papadamou
Eirini
E
Rigopoulou
Maria
M
Ioannou
Ioannis
I
Skoularigis
Georgios N
GN
Dalekos
D004452:Echocardiography; D006099:Granuloma / Q000150:complications / Q000188:drug therapy*; D006505:Hepatitis / Q000150:complications / Q000188:drug therapy*; D020065:Hepatopulmonary Syndrome / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged
D008775:Methylprednisolone