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Prolonged Unexplained Hypoxemia as Initial Presentation of Cirrhosis: A Case Report

Anand Puttappa, Kumaraswamy Sheshadri, Aurelie Fabre, Georgina Imberger, John Boylan, Silke Ryan, Masood Iqbal, Niamh Conlon

(Department of Anaesthesia and Intensive Care, St Vincent’s University Hospital, Dublin, Ireland)

Am J Case Rep 2017; 18:1-6

DOI: 10.12659/AJCR.900530


BACKGROUND: Hepatopulmonary syndrome (HPS) is a pulmonary complication of advanced liver disease with dyspnea as the predominant presenting symptom. The diagnosis of HPS can often be missed due to its nonspecific presentation and the presence of other comorbidities.
CASE REPORT: We present an interesting case of an obese 43-year-old man who presented with progressive, unexplained hypoxemia and shortness of breath in the absence of any symptoms or signs of chronic liver disease. After extensive cardiopulmonary investigations, he was diagnosed with severe HPS as a result of non-alcoholic steatohepatitis (NASH) leading to cirrhosis. He subsequently underwent successful hepatic transplantation and continues to improve at 12-month follow-up.
CONCLUSIONS: HPS needs to be considered in the differential diagnosis of unexplained hypoxemia. Given its poor prognosis, early diagnosis is warranted and treatment with liver transplantation is the preferred choice.

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