Phrathep Davong D, Anthony Stefan, Healey Kevin D, Khan Hamaad, Herman Michael
College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA.
Urology, Lake Erie College of Osteopathic Medicine, Bradenton, USA.
Cureus. 2023 Mar 19;15(3):e36364. doi: 10.7759/cureus.36364. eCollection 2023 Mar.
Noncirrhotic portal hypertension (NCPH) has recently been found in human immunodeficiency virus (HIV)-infected patients taking didanosine. Here, we describe an HIV-infected patient with portal hypertension due to hepatoportal sclerosis who presented with hematemesis at the emergency department (ED). CT angiography of the abdomen and pelvis with and without contrast revealed a diminutive portal vein with corresponding massive lower esophageal varices and superior mesenteric vein to the right gonadal vein varices. Esophagogastroduodenoscopy (EGD) revealed grade II varices were found in the lower third of the esophagus, for which the patient's symptoms improved with emergency endoscopic band ligation, octreotide and didanosine discontinuation. Our case demonstrates a rare complication that can occur with continued didanosine use in an HIV-positive patient. We highlight the need for a standard diagnostic upper gastrointestinal endoscopy to screen for portal hypertension and high-risk esophageal varices in patients with long-term didanosine use as seen in our patient.
非肝硬化性门静脉高压症（NCPH）最近在服用去羟肌苷的人类免疫缺陷病毒（HIV）感染患者中被发现。在此，我们描述一名因肝门静脉硬化导致门静脉高压的HIV感染患者，该患者在急诊科（ED）出现呕血。腹部和盆腔的CT血管造影（有无对比剂）显示门静脉细小，伴有相应的巨大食管下段静脉曲张以及肠系膜上静脉至右性腺静脉的静脉曲张。食管胃十二指肠镜检查（EGD）显示在食管下三分之一处发现II级静脉曲张，患者的症状通过急诊内镜套扎、奥曲肽和停用去羟肌苷得到改善。我们的病例展示了HIV阳性患者持续使用去羟肌苷可能发生的一种罕见并发症。我们强调，对于长期使用去羟肌苷的患者，如我们的患者，需要进行标准的诊断性上消化道内镜检查以筛查门静脉高压和高危食管静脉曲张。
