Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Tochigi-ken, Japan.
Department of Pediatrics, Jichi Medical University, Tochigi-ken, Japan.
Transplant Proc. 2021 May;53(4):1317-1321. doi: 10.1016/j.transproceed.2020.10.033. Epub 2021 Jan 16.
Myotubular myopathy is a rare disease sometimes accompanied by peliosis hepatis, a leading cause of fatal liver hemorrhage.
We present a case of a 2-year-old boy with myotubular myopathy who developed liver hemorrhage because of peliosis hepatis and was successfully treated with living-donor liver transplant. The patient initially presented with fever, anemia, and liver dysfunction. A computed tomographic scan revealed hemorrhages in the liver, and the patient underwent hepatic artery embolization twice. After the second embolization, multiple peliosis hepatis cavities appeared in the left lobe of the liver that had increased in size. Therefore, the patient underwent ABO-incompatible living-donor liver transplant using a lateral segment graft from his father. The patient developed severe septic shock with an unknown focus on postoperative day 18, which resolved with antibiotic therapy. On postoperative day 62, he was discharged. Fourteen months after undergoing living-donor liver transplant, the patient showed no recurrence of peliosis hepatis.
Although the long-term prognosis of peliosis hepatis due to myotubular myopathy after living-donor liver transplant remains unclear, liver transplant may be a curative treatment for patients with myotubular myopathy who have uncontrollable peliosis hepatis.
先天性肌小管肌病是一种罕见疾病,有时伴有肝血窦增生症,后者是导致致命性肝出血的主要原因。
我们报告了一例 2 岁男孩患先天性肌小管肌病的病例,该患儿因肝血窦增生症导致肝出血,并成功接受了活体肝移植治疗。患儿最初表现为发热、贫血和肝功能障碍。计算机断层扫描显示肝脏出血,患儿接受了两次肝动脉栓塞术。第二次栓塞术后,左叶出现多个增大的肝血窦腔,因此患儿接受了来自父亲的外侧段供肝的 ABO 不相容活体肝移植。术后第 18 天,患儿发生原因不明的严重脓毒性休克,经抗生素治疗后缓解。术后第 62 天,患儿出院。活体肝移植后 14 个月,患儿未再出现肝血窦增生症复发。
虽然先天性肌小管肌病患者接受活体肝移植后因肝血窦增生症的长期预后尚不清楚,但肝移植可能是治疗无法控制的肝血窦增生症的先天性肌小管肌病患者的一种治愈方法。