Case Report
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jan 14, 2006; 12(2): 336-339
Published online Jan 14, 2006. doi: 10.3748/wjg.v12.i2.336
Reversion of severe hepatopulmonary syndrome in a non cirrhotic patient after corticosteroid treatment for granulomatous hepatitis: A case report and review of the literature
Nikolaos Tzovaras, Aggelos Stefos, Sarah P Georgiadou, Nikolaos Gatselis, Georgia Papadamou, Eirini Rigopoulou, Maria Ioannou, Ioannis Skoularigis, Georgios N Dalekos
Nikolaos Tzovaras, Aggelos Stefos, Nikolaos Gatselis, Georgia Papadamou, Eirini Rigopoulou, Sarah P. Georgiadou, Georgios N. Dalekos, Department of Medicine, Academic Liver Unit, Medical School, University of Thessaly, 41222 Larissa, Greece
Maria Ioannou, Department of Pathology, Medical School, University of Thessaly, 41222 Larissa, Greece
Ioannis Skoularigis, Division of Cardiology, Medical School, University of Thessaly, 41222 Larissa, Greece
Correspondence to: Georgios N Dalekos, MD, PhD, Associate Professor of Medicine, Department of Medicine, Academic Liver Unit, Medical School, University of Thessaly, Papakiriazi 22 str, 41222 Larissa, Greece. dalekos@med.uth.gr
Telephone: +30-2410-565251 Fax: +30-2410-565250
Received: June 15, 2005
Revised: June 28, 2005
Accepted: July 10, 2005
Published online: January 14, 2006
Abstract

Hepatopulmonary syndrome (HPS) is defined as a clinical triad including liver disease, abnormal pulmonary gas exchange and evidence of intrapulmonary vascular dilatations. We report a 61-year-old male presented with fatigue, long-lasting fever, loss of weight, signs of portal hypertension, hepatosplenomegaly, cholestasis and progressive dyspnoea over the last year. Clinical, laboratory and histological findings confirmed the diagnosis of granulomatous hepatitis. HPS due to hepatic granuloma-induced portal hypertension was proved to be the cause of severe hypoxemia of the patient as confirmed by contrast-enhanced echocardiography. Reversion of HPS after corticosteroid therapy was confirmed by a new contrast-enhanced echocardiography along with the normalization of cholestatic enzymes and improvement of the patient’s conditions. This is the first case of complete reversion of HPS in a non-cirrhotic patient with hepatic granuloma, indicating that intrapulmonary shunt in liver diseases is a functional phenomenon and HPS can be developed even in miscellaneous liver involvement as in this case.

Keywords: Hepatopulmonary syndrome, Granulomatous hepatitis, Liver cirrhosis, Orthodeoxia, Platypnoea