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

  • Akio MiyasakaEmail author
  • Yuichi Yoshida
  • Akiko Suzuki
  • Hironobu Ueda
  • Yoshihiro Morino
  • Yasuhiro Takikawa
Case Report

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.

Keywords

Pulmonary hypertension HCV infection Portal-pulmonary hypertension Direct-acting antivirals 

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

Notes

Acknowledgements

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

Compliance with ethical standards

Conflict of interest

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

Human/animal rights

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

Informed Consent

Informed consent was obtained from the patient in our study.

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Copyright information

© Japanese Society of Gastroenterology 2019

Authors and Affiliations

  1. 1.Division of Hepatology, Department of Internal MedicineIwate Medical University School of MedicineMoriokaJapan
  2. 2.Division of Cardiology, Department of Internal MedicineIwate Medical University School of MedicineMoriokaJapan

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