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A case of suspected portal-pulmonary hypertension due to hepatitis C virus infection

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Abstract

A 44-year-old woman with chronic hepatitis C virus (HCV) infection was referred by a primary care doctor and admitted to our hospital because of worsening dyspnea on exertion and right atrial and ventricular enlargement. The patient was diagnosed with pulmonary arterial hypertension (PAH) associated with portal hypertension induced by chronic HCV infection. This diagnosis was based on a cardiological examination and findings related to liver cirrhosis with portal hypertension. After the prescription of anti-PAH medicine and a slight improvement in her respiratory symptoms, 12-week direct-acting antiviral (DAA) treatment for HCV was started. Serum HCV RNA levels rapidly decreased and HCV elimination was confirmed 24 weeks after completing DAA treatment. Before confirmation of a sustained virological response at 24 weeks after completing DAA treatment, a remarkable improvement in her cardiac markers was found in a right heart catheter study. This study was performed 6 weeks after the end of DAA administration. Therefore, we considered that HCV infection was involved in the development of PAH and that elimination of HCV by interferon-free treatment was important for this patient.

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Abbreviations

PH:

Pulmonary hypertension

PAP:

Pulmonary arterial pressure

RHC:

Right heart catheterization

PAH:

Pulmonary arterial hypertension

POPH:

Portal-pulmonary hypertension

IFN:

Interferon

HCV:

Hepatitis C virus

DAA:

Direct-acting antiviral

SVR:

Sustained virological response

NYHA:

New York Heart Association

BNP:

Brain natriuretic peptide

CT:

Computed tomography

CI:

Cardiac Index

STAT3:

Signal transducer and activator of transcription 3

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Acknowledgements

We thank Ellen Knapp, PhD, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, 020-8505, Japan

    Akio Miyasaka, Yuichi Yoshida, Akiko Suzuki & Yasuhiro Takikawa

  2. Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Japan

    Hironobu Ueda & Yoshihiro Morino

Authors
  1. Akio Miyasaka
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  2. Yuichi Yoshida
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  3. Akiko Suzuki
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  4. Hironobu Ueda
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  5. Yoshihiro Morino
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  6. Yasuhiro Takikawa
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Correspondence to Akio Miyasaka.

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The authors declare no conflicts of interest in association with the present study.

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All procedures followed were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from the patient in our study.

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Miyasaka, A., Yoshida, Y., Suzuki, A. et al. A case of suspected portal-pulmonary hypertension due to hepatitis C virus infection. Clin J Gastroenterol 13, 90–96 (2020). https://doi.org/10.1007/s12328-019-01016-3

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  • DOI: https://doi.org/10.1007/s12328-019-01016-3

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