Shrestha Riya, Karki Saurab, Timilsina Bibek, Sherpa Tenzin Norphel, Sapkota Suhail, Dhakal Binaya, Kadel Bijan
Nepal Medical College, Kathmandu, Nepal.
Military Hospital, Sunsari, Nepal.
Ann Med Surg (Lond). 2022 Sep 7;82:104607. doi: 10.1016/j.amsu.2022.104607. eCollection 2022 Oct.
Bud-Chiari syndrome is an uncommon disease due to obstruction of hepatic venous outflow. Clinical manifestations range from asymptomatic cases to those requiring liver transplants. The study highlights the importance of diagnosing a case of Budd-Chiari syndrome which has been suspected with abdominal tuberculosis where anti-tubercular drugs may themselves damage the liver.
Herein we report a case of 18 years old female presenting with upper abdominal pain along with recurrent abdominal distention, jaundice, and deranged liver function. Also, adenosine deaminase level was raised in both pleural and peritoneal fluids, hence, anti-tubercular treatment was started but could not be continued as she developed adverse reactions to these drugs. CT scan later revealed features suggestive of Budd-Chiari syndrome. Initially, she was managed with balloon angioplasty, but her condition worsened ultimately requiring a liver transplant.
Budd Chiari syndrome can present with subtle presentation and since abdominal tuberculosis is very non-specific, the two conditions can be very confusing, particularly in the tubercular endemic region. Detailed clinical assessment along with proper investigations and imaging should be performed for early recognition as both conditions are associated with high morbidity and mortality if not treated timely.
The necessity of careful investigation and consideration of Budd-Chiari syndrome as an important cause of ascites with jaundice and deranged liver function in TB endemic regions along with early anticipation of liver transplant is necessary, as in this case.
布加综合征是一种因肝静脉流出道梗阻引起的罕见疾病。临床表现从无症状病例到需要进行肝移植的病例不等。该研究强调了诊断一例疑似腹部结核的布加综合征病例的重要性，因为抗结核药物本身可能会损害肝脏。
在此，我们报告一例18岁女性患者，表现为上腹部疼痛，伴有反复腹胀、黄疸和肝功能紊乱。此外，胸腔和腹腔积液中的腺苷脱氨酶水平升高，因此开始进行抗结核治疗，但由于她对这些药物出现不良反应而无法继续治疗。CT扫描后来显示出提示布加综合征的特征。最初，她接受了球囊血管成形术治疗，但病情最终恶化，需要进行肝移植。
布加综合征可能表现得较为隐匿，而且由于腹部结核非常不具有特异性，这两种情况可能非常容易混淆，尤其是在结核病流行地区。应进行详细的临床评估以及适当的检查和影像学检查以便早期识别，因为如果不及时治疗，这两种情况都与高发病率和死亡率相关。
如本病例所示，在结核病流行地区，仔细调查并将布加综合征视为黄疸和肝功能紊乱伴腹水的重要病因，并尽早考虑肝移植是必要的。
