Chayanupatkul Maneerat, Rhee Ji Hyun, Kumar Anand Raman, Varadi Gabor
Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA.
BMJ Case Rep. 2012 Dec 4;2012:bcr2012007411. doi: 10.1136/bcr-2012-007411.
We reported a rare case of Budd-Chiari syndrome (BCS) associated with tamoxifen use, which was later complicated by heparin-induced thrombocytopenia and thrombosis (HITT). The patient was a 44 year-old woman with a medical history of lobular carcinoma in situ, who had been on tamoxifen for 2 years, presented with abdominal pain and distention. Imaging studies followed by a liver biopsy confirmed the diagnosis of BCS. On extensive work-up, the patient was found to have an unclassified myeloproliferative disorder with positive JAK-2 V617 mutation. After discontinuing tamoxifen, the patient was started on intravenous heparin. However, later in the course, she developed HITT. Myeloproliferative disorder, in conjunction with tamoxifen, predisposed the patient to be highly thrombophilic resulting in BCS. HITT was found to be relatively common in BCS. Anticoagulation and blood count need to be carefully monitored, and the possibility of HITT emergence in these patients should always be kept in mind.
我们报告了一例罕见的与他莫昔芬使用相关的布加综合征（BCS）病例，该病例随后并发肝素诱导的血小板减少症和血栓形成（HITT）。患者为一名44岁女性，有小叶原位癌病史，服用他莫昔芬2年，出现腹痛和腹胀。影像学检查及肝活检确诊为BCS。经过全面检查，发现该患者患有未分类的骨髓增殖性疾病，JAK-2 V617突变呈阳性。停用他莫昔芬后，患者开始静脉注射肝素。然而，在病程后期，她发生了HITT。骨髓增殖性疾病与他莫昔芬共同作用，使患者具有高度血栓形成倾向，导致BCS。HITT在BCS中相对常见。抗凝和血常规需要仔细监测，应始终牢记这些患者出现HITT的可能性。
