Epoprostenol-induced hypersplenism in portopulmonary hypertension.
Portopulmonary hypertension (POPH) is a not infrequent but serious complication of liver cirrhosis. Continuous intravenous epoprostenol infusion is a treatment option for this condition. Progressive splenomegaly with pancytopenia (hypersplenism) is associated with epoprostenol use in POPH. After recognizing a case of epoprostenol-induced hypersplenism that resolved upon stopping the drug, the authors retrospectively reviewed all patients treated with epoprostenol at the center for both POPH and pulmonary hypertension due to other causes. Five of 11 patients with POPH developed hypersplenism secondary to epoprostenol. In 1 patient, and possibly in a second, the hypersplenism resolved upon discontinuation of epoprostenol. None of 9 patients with pulmonary hypertension due to other causes developed splenomegaly. This report confirms hypersplenism as a complication of epoprostenol therapy for POPH. Furthermore, the authors demonstrate for the first time that hypersplenism may be reversed by stopping the medication and propose a mechanism for this phenomenon.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.
Waseem
W
Touma
Ravi P
RP
Nayak
Zulfiqar
Z
Hussain
Bruce R
BR
Bacon
Ganesh C
GC
Kudva
D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D011464:Epoprostenol / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy*; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D013163:Splenomegaly / Q000139:chemically induced*
D000959:Antihypertensive Agents; D011464:Epoprostenol