Case Report
Copyright ©2014 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Mar 7, 2014; 20(9): 2420-2425
Published online Mar 7, 2014. doi: 10.3748/wjg.v20.i9.2420
Peliosis hepatis complicated by portal hypertension following renal transplantation
Chia-Ying Yu, Liang-Che Chang, Li-Wei Chen, Tsung-Shih Lee, Rong-Nan Chien, Ming-Fang Hsieh, Kun-Chun Chiang
Chia-Ying Yu, Li-Wei Chen, Tsung-Shih Lee, Rong-Nan Chien, Department of Gastroenterology, Chang Gung Memorial Hospital and University at Keelung, Keelung 20401, Taiwan
Liang-Che Chang, Department of Pathology, Chang Gung Memorial Hospital and University at Keelung, Keelung 20401, Taiwan
Ming-Fang Hsieh, Division of Nephrology, Department of Gastroenterology, Chang Gung Memorial Hospital and University at Keelung, Keelung 20401, Taiwan
Kun-Chun Chiang, Department of General Surgery, Chang Gung Memorial Hospital and University at Keelung, Keelung 20401, Taiwan
Author contributions: Yu CY and Chen LW designed the review; Chen LW, Lee TS, Chien RN and Hsieh MF were the attending doctors for the patients; Chiang KC performed the surgical operation; Chang LC performed the pathological examination; Chen LW organized the review; Yu CY wrote the manuscript.
Correspondence to: Li-Wei Chen, MD, Department of Gastroenterology, Chang Gung Memorial Hospital and University at Keelung, 222 Mai-Jin Road, Keelung 20401, Taiwan. leiwei@adm.cgmh.org.tw
Telephone: +886-2-24313131 Fax: +886-2-24335342
Received: September 8, 2013
Revised: November 27, 2013
Accepted: January 2, 2014
Published online: March 7, 2014
Abstract

Peliosis hepatis (PH) is a vascular lesion of the liver that mimics a hepatic tumor. PH is often associated with underlying conditions, such as chronic infection and tumor malignancies, or with the use of anabolic steroids, immunosuppressive drugs, and oral contraceptives. Most patients with PH are asymptomatic, but some present with abdominal distension and pain. In some cases, PH may induce intraperitoneal hemorrhage and portal hypertension. This study analyzed a 46-year-old male who received a transplanted kidney nine years prior and had undergone long-term immunosuppressive therapy following the renal transplantation. The patient experienced progressive abdominal distention and pain in the six months prior to this study. Initially, imaging studies revealed multiple liver tumor-like abnormalities, which were determined to be PH by pathological analysis. Because the hepatic lesions were progressively enlarged, the patient suffered from complications related to portal hypertension, such as intense ascites and esophageal varices bleeding. Although the patient was scheduled to undergo liver transplantation, he suffered hepatic failure and died prior to availability of a donor organ.

Keywords: Peliosis hepatis, Liver neoplasm, Portal hypertension, Renal failure, Renal transplantation

Core tip: Peliosis hepatis (PH) is a vascular lesion of the liver that mimics a hepatic tumor. PH has been associated with the use of anabolic steroids or immunosuppressive drugs. Although most patients remain asymptomatic, some patients suffer from PH-related portal hypertension complications. This case study describes a 46-year-old man who underwent long-term immunosuppressive therapy following renal transplantation. Upon development of abdominal distention, PH was diagnosed by pathological analysis. Ultimately, the patient suffered hepatic failure when the immunosuppressive agent was withdrawn and died.