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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Vydáno v:BMC gastroenterology Ročník 10; číslo 1; s. 6
Hlavní autoři: Bihl, Florian, Janssens, Filip, Boehlen, Francoise, Rubbia-Brandt, Laura, Hadengue, Antoine, Spahr, Laurent
Médium: Journal Article
Jazyk:angličtina
Vydáno: London BioMed Central 18.01.2010
BioMed Central Ltd
BMC
Témata:
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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Shrnutí: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.
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ISSN:1471-230X
1471-230X
DOI:10.1186/1471-230X-10-6