Anticoagulant therapy for nodular regenerative hyperplasia in a HIV-infected patient

Background Nodular regenerative hyperplasia (NRH) has been recently recognized as an emergent cause of liver disease in HIV-infected patients. NRH may cause non-cirrhotic portal hypertension with potentially severe consequences such as refractory ascites, variceal bleeding and hypersplenism. Obliter...

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Veröffentlicht in:	BMC gastroenterology Jg. 10; H. 1; S. 6
Hauptverfasser:	Bihl, Florian, Janssens, Filip, Boehlen, Francoise, Rubbia-Brandt, Laura, Hadengue, Antoine, Spahr, Laurent
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	London BioMed Central 18.01.2010 BioMed Central Ltd BMC
Schlagworte:	Abdominal Pain - etiology Adult Anticoagulants (Medicine) Ascites - diagnosis Ascites - etiology Biopsy Care and treatment Case Report Case studies Dosage and administration Esophageal and Gastric Varices - diagnosis Esophageal and Gastric Varices - etiology Female Gastroenterology Heparin, Low-Molecular-Weight - therapeutic use Hepatology HIV infection HIV Infections - complications Humans Hyperplasia Hyperplasia - etiology Hyperplasia - pathology Hypertension, Portal - drug therapy Hypertension, Portal - etiology Internal Medicine Liver - pathology Lymph Nodes - pathology Medicine Medicine & Public Health Remission Induction Splenomegaly - diagnosis Splenomegaly - etiology Switzerland Thrombophilia Portal Hypertension Atazanavir Transjugular Intrahepatic Portosystemic Shunt Variceal Bleeding
ISSN:	1471-230X, 1471-230X
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Abstract	Background Nodular regenerative hyperplasia (NRH) has been recently recognized as an emergent cause of liver disease in HIV-infected patients. NRH may cause non-cirrhotic portal hypertension with potentially severe consequences such as refractory ascites, variceal bleeding and hypersplenism. Obliteration of the small intrahepatic portal veins in association with prothrombotic disorders linked to HIV infection itself or anti-retroviral therapy seem to be the causes of NRH and thus the term HIV-associated obliterative portopathy has been proposed. Case Presentation Here we describe a case of a HIV-infected patient with biopsy-proven NRH and listed for liver transplantation (LT) because of refractory ascites and repeated upper gastrointestinal bleedings. A transjugular intrahepatic portosystemic shunt was placed as a bridge to LT and did not improve liver function. However, anticoagulant therapy with low-molecular-weight heparin (LMWH) was associated with rapid improvement in the liver condition and allowed to avoid LT in this patient. Conclusions Thus, this case underscores the relation between thrombophilia and HIV-associated NRH and emphasizes anticoagulant therapy as possible treatment.
AbstractList	Nodular regenerative hyperplasia (NRH) has been recently recognized as an emergent cause of liver disease in HIV-infected patients. NRH may cause non-cirrhotic portal hypertension with potentially severe consequences such as refractory ascites, variceal bleeding and hypersplenism. Obliteration of the small intrahepatic portal veins in association with prothrombotic disorders linked to HIV infection itself or anti-retroviral therapy seem to be the causes of NRH and thus the term HIV-associated obliterative portopathy has been proposed. Here we describe a case of a HIV-infected patient with biopsy-proven NRH and listed for liver transplantation (LT) because of refractory ascites and repeated upper gastrointestinal bleedings. A transjugular intrahepatic portosystemic shunt was placed as a bridge to LT and did not improve liver function. However, anticoagulant therapy with low-molecular-weight heparin (LMWH) was associated with rapid improvement in the liver condition and allowed to avoid LT in this patient. Thus, this case underscores the relation between thrombophilia and HIV-associated NRH and emphasizes anticoagulant therapy as possible treatment. Background Nodular regenerative hyperplasia (NRH) has been recently recognized as an emergent cause of liver disease in HIV-infected patients. NRH may cause non-cirrhotic portal hypertension with potentially severe consequences such as refractory ascites, variceal bleeding and hypersplenism. Obliteration of the small intrahepatic portal veins in association with prothrombotic disorders linked to HIV infection itself or anti-retroviral therapy seem to be the causes of NRH and thus the term HIV-associated obliterative portopathy has been proposed. Case Presentation Here we describe a case of a HIV-infected patient with biopsy-proven NRH and listed for liver transplantation (LT) because of refractory ascites and repeated upper gastrointestinal bleedings. A transjugular intrahepatic portosystemic shunt was placed as a bridge to LT and did not improve liver function. However, anticoagulant therapy with low-molecular-weight heparin (LMWH) was associated with rapid improvement in the liver condition and allowed to avoid LT in this patient. Conclusions Thus, this case underscores the relation between thrombophilia and HIV-associated NRH and emphasizes anticoagulant therapy as possible treatment. Abstract Background Nodular regenerative hyperplasia (NRH) has been recently recognized as an emergent cause of liver disease in HIV-infected patients. NRH may cause non-cirrhotic portal hypertension with potentially severe consequences such as refractory ascites, variceal bleeding and hypersplenism. Obliteration of the small intrahepatic portal veins in association with prothrombotic disorders linked to HIV infection itself or anti-retroviral therapy seem to be the causes of NRH and thus the term HIV-associated obliterative portopathy has been proposed. Case Presentation Here we describe a case of a HIV-infected patient with biopsy-proven NRH and listed for liver transplantation (LT) because of refractory ascites and repeated upper gastrointestinal bleedings. A transjugular intrahepatic portosystemic shunt was placed as a bridge to LT and did not improve liver function. However, anticoagulant therapy with low-molecular-weight heparin (LMWH) was associated with rapid improvement in the liver condition and allowed to avoid LT in this patient. Conclusions Thus, this case underscores the relation between thrombophilia and HIV-associated NRH and emphasizes anticoagulant therapy as possible treatment. Nodular regenerative hyperplasia (NRH) has been recently recognized as an emergent cause of liver disease in HIV-infected patients. NRH may cause non-cirrhotic portal hypertension with potentially severe consequences such as refractory ascites, variceal bleeding and hypersplenism. Obliteration of the small intrahepatic portal veins in association with prothrombotic disorders linked to HIV infection itself or anti-retroviral therapy seem to be the causes of NRH and thus the term HIV-associated obliterative portopathy has been proposed. Thus, this case underscores the relation between thrombophilia and HIV-associated NRH and emphasizes anticoagulant therapy as possible treatment. Background Nodular regenerative hyperplasia (NRH) has been recently recognized as an emergent cause of liver disease in HIV-infected patients. NRH may cause non-cirrhotic portal hypertension with potentially severe consequences such as refractory ascites, variceal bleeding and hypersplenism. Obliteration of the small intrahepatic portal veins in association with prothrombotic disorders linked to HIV infection itself or anti-retroviral therapy seem to be the causes of NRH and thus the term HIV-associated obliterative portopathy has been proposed. Case Presentation Here we describe a case of a HIV-infected patient with biopsy-proven NRH and listed for liver transplantation (LT) because of refractory ascites and repeated upper gastrointestinal bleedings. A transjugular intrahepatic portosystemic shunt was placed as a bridge to LT and did not improve liver function. However, anticoagulant therapy with low-molecular-weight heparin (LMWH) was associated with rapid improvement in the liver condition and allowed to avoid LT in this patient. Conclusions Thus, this case underscores the relation between thrombophilia and HIV-associated NRH and emphasizes anticoagulant therapy as possible treatment. Nodular regenerative hyperplasia (NRH) has been recently recognized as an emergent cause of liver disease in HIV-infected patients. NRH may cause non-cirrhotic portal hypertension with potentially severe consequences such as refractory ascites, variceal bleeding and hypersplenism. Obliteration of the small intrahepatic portal veins in association with prothrombotic disorders linked to HIV infection itself or anti-retroviral therapy seem to be the causes of NRH and thus the term HIV-associated obliterative portopathy has been proposed.BACKGROUNDNodular regenerative hyperplasia (NRH) has been recently recognized as an emergent cause of liver disease in HIV-infected patients. NRH may cause non-cirrhotic portal hypertension with potentially severe consequences such as refractory ascites, variceal bleeding and hypersplenism. Obliteration of the small intrahepatic portal veins in association with prothrombotic disorders linked to HIV infection itself or anti-retroviral therapy seem to be the causes of NRH and thus the term HIV-associated obliterative portopathy has been proposed.Here we describe a case of a HIV-infected patient with biopsy-proven NRH and listed for liver transplantation (LT) because of refractory ascites and repeated upper gastrointestinal bleedings. A transjugular intrahepatic portosystemic shunt was placed as a bridge to LT and did not improve liver function. However, anticoagulant therapy with low-molecular-weight heparin (LMWH) was associated with rapid improvement in the liver condition and allowed to avoid LT in this patient.CASE PRESENTATIONHere we describe a case of a HIV-infected patient with biopsy-proven NRH and listed for liver transplantation (LT) because of refractory ascites and repeated upper gastrointestinal bleedings. A transjugular intrahepatic portosystemic shunt was placed as a bridge to LT and did not improve liver function. However, anticoagulant therapy with low-molecular-weight heparin (LMWH) was associated with rapid improvement in the liver condition and allowed to avoid LT in this patient.Thus, this case underscores the relation between thrombophilia and HIV-associated NRH and emphasizes anticoagulant therapy as possible treatment.CONCLUSIONSThus, this case underscores the relation between thrombophilia and HIV-associated NRH and emphasizes anticoagulant therapy as possible treatment.
ArticleNumber	6
Audience	Academic
Author	Boehlen, Francoise Hadengue, Antoine Spahr, Laurent Bihl, Florian Rubbia-Brandt, Laura Janssens, Filip
AuthorAffiliation	3 Department of Pathology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 1211, Switzerland 2 Department of Hematology, Service of Angiology and Hemostasis, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 1211, Switzerland 1 Department of Gastroenterology and Hepatology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 1211, Switzerland
AuthorAffiliation_xml	– name: 1 Department of Gastroenterology and Hepatology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 1211, Switzerland – name: 2 Department of Hematology, Service of Angiology and Hemostasis, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 1211, Switzerland – name: 3 Department of Pathology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 1211, Switzerland
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Keywords	Thrombophilia Portal Hypertension Atazanavir Transjugular Intrahepatic Portosystemic Shunt Variceal Bleeding
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Snippet	Background Nodular regenerative hyperplasia (NRH) has been recently recognized as an emergent cause of liver disease in HIV-infected patients. NRH may cause... Nodular regenerative hyperplasia (NRH) has been recently recognized as an emergent cause of liver disease in HIV-infected patients. NRH may cause non-cirrhotic... Background Nodular regenerative hyperplasia (NRH) has been recently recognized as an emergent cause of liver disease in HIV-infected patients. NRH may cause... Abstract Background Nodular regenerative hyperplasia (NRH) has been recently recognized as an emergent cause of liver disease in HIV-infected patients. NRH may...
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SubjectTerms	Abdominal Pain - etiology Adult Anticoagulants (Medicine) Ascites - diagnosis Ascites - etiology Biopsy Care and treatment Case Report Case studies Dosage and administration Esophageal and Gastric Varices - diagnosis Esophageal and Gastric Varices - etiology Female Gastroenterology Heparin, Low-Molecular-Weight - therapeutic use Hepatology HIV infection HIV Infections - complications Humans Hyperplasia Hyperplasia - etiology Hyperplasia - pathology Hypertension, Portal - drug therapy Hypertension, Portal - etiology Internal Medicine Liver - pathology Lymph Nodes - pathology Medicine Medicine & Public Health Remission Induction Splenomegaly - diagnosis Splenomegaly - etiology
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Title	Anticoagulant therapy for nodular regenerative hyperplasia in a HIV-infected patient
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