title: A case of non-cirrhotic portal hypertension associated with anti-retroviral therapy in a Japanese patient with human immunodeficiency virus infection.
abstract: The diagnosis of non-cirrhotic portal hypertension (NCPH), a rare but potentially life-threatening complication in human immunodeficiency virus (HIV)-positive individuals, often occurs only after the emergence of fatal manifestations such as bleeding of esophageal varices. We herein report a female Japanese HIV patient who developed NCPH approximately 4 years after discontinuation of 65 months of didanosine (ddI) administration. The patient presented with severe ascites, bloody bowel discharge, extreme abdominal swelling, and symptoms of portal hypertension but no sign of liver cirrhosis. Examination revealed esophageal varices, oozing-like bleeding from a wide part of the colon, significant atrophy of the right lobe of the liver, and arterio-portal shunting and recanalization from the left medial segment branch of the portal vein to a paraumbilical vein, but no visible obstruction of the main trunk of the portal vein. Treatment for esophageal varices consisted of coagulation therapy with argon plasma after enforcement by endoscopic sclerotherapy and oral administration of β-blockers for elevated portal blood pressure. The patient has not experienced gastrointestinal bleeding in the approximately 5 years since the diagnosis of NCPH. Reviewing this case suggests the importance of suspecting NCPH in HIV patients with liver dysfunction of unknown etiology with a history of ddI and other purine analogs use, as well as the importance of controlling portal hypertension and esophageal varices in the treatment of NCPH.
authors.affiliation: AIDS Medical Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka 540-0006, Japan. Electronic address: yaji-k@onh.go.jp.
authors.forename: Keishiro
authors.initials: K
authors.lastname: Yajima
authors.affiliation: AIDS Medical Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka 540-0006, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Uehira
authors.affiliation: AIDS Medical Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka 540-0006, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Otera
authors.affiliation: AIDS Medical Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka 540-0006, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Koizumi
authors.affiliation: AIDS Medical Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka 540-0006, Japan.
authors.forename: Dai
authors.initials: D
authors.lastname: Watanabe
authors.affiliation: Histopathology, National Hospital Organization Osaka National Hospital, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Kodama
authors.affiliation: Departments of Gastroenterology, National Hospital Organization Osaka National Hospital, Japan.
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Kuzushita
authors.affiliation: AIDS Medical Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka 540-0006, Japan.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Nishida
authors.affiliation: Departments of Gastroenterology, National Hospital Organization Osaka National Hospital, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Mita
authors.affiliation: Histopathology, National Hospital Organization Osaka National Hospital, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Mano
authors.affiliation: AIDS Medical Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka 540-0006, Japan.
authors.forename: Takuma
authors.initials: T
authors.lastname: Shirasaka
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016049:Didanosine / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000821:virology*; D008103:Liver Cirrhosis / Q000503:physiopathology* / Q000821:virology*
chemical_list: D044966:Anti-Retroviral Agents; D016049:Didanosine
keywords: Didanosine; HIV; Non-cirrhotic portal hypertension; Purine analog