Abstract
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.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.ConclusionsThus, this case underscores the relation between thrombophilia and HIV-associated NRH and emphasizes anticoagulant therapy as possible treatment.
Highlights
Nodular regenerative hyperplasia (NRH) has been recently recognized as an emergent cause of liver disease in human immuno deficiency virus (HIV)-infected patients
Conclusions: this case underscores the relation between thrombophilia and HIV-associated NRH and emphasizes anticoagulant therapy as possible treatment
Sinusoidal dilatation is secondary to an increased blood flow. The sum of these events has recently be described by Mallet et al coining the term HIV-associated obliterative portopathy (HIV-OP) [10]
Summary
Nodular regenerative hyperplasia (NRH) has been recently recognized as an emergent cause of liver disease in HIV-infected patients. Conclusions: this case underscores the relation between thrombophilia and HIV-associated NRH and emphasizes anticoagulant therapy as possible treatment. Several reports described HIV-infected patients with symptomatic NCPH revealing NRH [1,2,3,4,5,6,7,8,9,10,11,12,13].
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