A 52-year-old woman with hepatitis C virus infection, genotype 1b, with a high viral load (> 5 E5 IU/ ml) presented to the clinic complaining of asthenia and spontaneous skin lesions in the chest.
The physical examination revealed mild stenosis and sepsis in the nasal region and thorax.
GOT 108 U/l, GPT 113 U/l, GGT 131 U/trodl, alkaline phosphatase 162/40 U/l, total bilirubin 2.3 mg/l, albumin 3.5 g/trodl, albumin 11000 U/l.
Abdominal ultrasound: heteroechoic liver, irregular surface with hypertrophy of the caudate lobe.
Permeable port of 10 mm. Bazo 14 cm. Upper gastrointestinal endoscopy: no esophageal or gastric varices; no signs of portal hypertension gastropathy.
Treatment was initiated with combined therapy with PegINF alfa 2a 180 mg/week sc. and ribavirin 1000 mg/day, suspended at 12 weeks due to lack of response.
During follow-up, the patient reported worsening of asthenia and dyspnea on moderate exertion.
at the same time, suspicion of hepatopulmonary syndrome was suspected; the short axis was established from the right ventricle ejection fraction 10 (HFV 101.8%), FEV1/FVC 87.52 and a sonic contrast echocardiogram was performed.
These findings establish the diagnosis of hepatopulmonary syndrome (4).
The patient presents new episodes of bleeding due to sepsis located in the chest that do not respond to cauterization, requiring surgical removal on two occasions.
Treatment with tamoxifen was started, reducing bleeding episodes. The patient was objectified three weeks after starting treatment absence of new bleeding episodes and stabilization of the number of lesions.
