RESOLUTION OF HEPATOPULMONARY SYNDROME WITH SUCCESSFUL TREATMENT OF CHRONIC HEPATITIS C INFECTION

Abstract

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Hepatopulmonary syndrome (HPS) is a serious complication of liver disease where pulmonary vasculature dilates causing hypoxia and dyspnea. The following case describes a patient had reversal of their HPS after successful treatment of their chronic hepatitis C virus (HCV) infection. CASE PRESENTATION: A 49-year-old female presented to the St. Paul Hospital in Saskatoon, Canada for hypoxemia. Her past medical history includes untreated human immunodeficiency virus (HIV) and HCV genotype 3 with associated cirrhosis. At presentation, the patient had a SpO2 of 78% on room air which improved to 88% with administration of 5L supplemental oxygen. HPS was suspected and a thoracic CT was performed which demonstrated enlargement of the pulmonary arterioles in the lower lung zones. The diagnosis of HPS was confirmed with a contrast echo demonstrating bubbles in the left atrium after approximately 4 cardiac cycles suggesting a large shunt. For symptomatic management , the patient was started on 4L of home O2 and referred to infectious diseases for management of the patients HIV and HCV. The patient was started immediately on emtricitabine, tenofovir alafenamide and dolutegravir for her HIV, developing undetectable viral loads and a CD4 count of 80 within 3 months of treatment. For her HCV, the patient was later started on a 12-week course of sofosbuvir, velpatasvir and ribavarin, which was confirmed to have eliminated her HCV infection at 24 weeks post-treatment. Following eradication of the patients HCV infection, the patient's hypoxia had also resolved with a measured SpO2 of 94% on room air. A follow-up contrast echo demonstrated few bubbles in the left atrium following 10 cardiac cycles, therefore suggesting successful treatment of HPS. DISCUSSION: HPS is characterized by hypoxia secondary to intrapulmonary vascular dilatations which cause an apparent right to left intrapulmonary shunt1. The syndrome leads to progressive hypoxemia and significant morbidity. There is currently no effective medical therapy for HPS, and liver transplantation is the only definitive treatment available2,3. Globally HCV infection is a major contributor to chronic liver disease, and therefore HPS. There has also been evidence of HPS occurring in non-cirrhotic patients with chronic viral hepatitis 4. With the introduction of direct-acting antivirals (DAAs), treatment of HCV has become more efficacious and well tolerated. The potential for successful treatment with DAAs to resolve HPS could lead to significant medical advances for the treatment of HPS. CONCLUSIONS: In conclusion this case report describes the successful reversal of HPS following the treatment of chronic HCV infection. These findings suggests that further research may discover a role for the use of DAAs in treatment of HPS. Reference #1: Grilo-Bensusan, I., & Pascasio-Acevedo, J. M. (2016). Hepatopulmonary syndrome: What we know and what we would like to know. World journal of gastroenterology, 22(25), 5728. Reference #2: Gupta, S., et al. (2010). Improved survival after liver transplantation in patients with hepatopulmonary syndrome. American Journal of Transplantation, 10(2), 354-363. Reference #3: Tzovaras, N., et al. (2006). Reversion of severe hepatopulmonary syndrome in a non cirrhotic patient after corticosteroid treatment for granulomatous hepatitis: a case report and review of the literature. World journal of gastroenterology: WJG, 12(2), 336. DISCLOSURES: No relevant relationships by Adam Bloom, source=Web Response Advisory Committee Member relationship with Gilead Please note: $1001 - $5000 Added 03/23/2019 by Kris Stewart, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Gilead Please note: $1001 - $5000 Added 03/23/2019 by Kris Stewart, source=Web Response, value=Honoraria Grant relationship with Gilead Please note: $20001 - $100000 Added 03/23/2019 by Kris Stewart, source=Web Response, value=Grant/Research Support Advisory Committee Member relationship with Abbvie Please note: $1001 - $5000 Added 03/23/2019 by Kris Stewart, source=Web Response, value=Consulting fee grant relationship with Abbvie Please note: $5001 - $20000 Added 03/23/2019 by Kris Stewart, source=Web Response, value=Grant/Research Support Grant relationship with Viiv Please note: $1001 - $5000 Added 03/23/2019 by Kris Stewart, source=Web Response, value=Grant/Research Support Advisory Committee Member relationship with Merck Please note: $1001 - $5000 Added 03/23/2019 by Kris Stewart, source=Web Response, value=Consulting fee Grant relationship with Merck Please note: $5001 - $20000 Added 03/23/2019 by Kris Stewart, source=Web Response, value=Grant/Research Support No relevant relationships by Chung Chun Tyan, source=Web Response