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Diagnostic étiologique de l’hypertension pulmonaire : une cause de diagnostic difficile
Revue des maladies respiratoires, 2019-03, Vol.36 (3), p.350-354
[Peer Reviewed Journal]
2018 SPLF ;ISSN: 0761-8425 ;DOI: 10.1016/j.rmr.2018.11.004
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Title:
Diagnostic étiologique de l’hypertension pulmonaire : une cause de diagnostic difficile
Author:
Rigaud, P.
;
Traclet, J.
;
Cottin, V.
Subjects:
Hypertension artérielle pulmonaire
;
Hypertension portale
;
Hypertension pulmonaire
;
Liver transplantation
;
Portal hypertension
;
Pulmonary arterial hypertension
;
Pulmonary hypertension
;
Schistosomiase
;
Schistosomiasis
;
Transplantation hépatique
Is Part Of:
Revue des maladies respiratoires, 2019-03, Vol.36 (3), p.350-354
Description:
L’hypertension artérielle pulmonaire associée à une schistosomiase fait partie du groupe 1 de la classification de l’hypertension pulmonaire et doit être évoquée chez tout patient ayant une hypertension pulmonaire et revenant d’une zone endémique. Un patient âgé de 17 ans est hospitalisé pour la découverte d’une hypertension pulmonaire lors d’un bilan initial d’une cirrhose virale par hépatite B avec hypertension portale. Le bilan initial a retenu comme diagnostic celui d’une hypertension portopulmonaire secondaire à la cirrhose virale B. L’état du patient s’est aggravé sur le plan hépatique et hémodynamique et il a bénéficié d’un traitement par epoprostenol intraveineux permettant secondairement la réalisation d’une transplantation hépatique. Au décours, l’epoprostenol a pu être arrêté. L’examen histologique de l’explant hépatique a mis en évidence de façon inattendue une schistosomiase floride en plus de l’atteinte virale B. Le diagnostic d’une hypertension artérielle pulmonaire associée à une schistosomiase peut être difficile. Il est nécessaire de répéter les examens sérologiques et parfois de recourir à la biopsie rectale. Le traitement de l’hypertension artérielle pulmonaire associée à une schistosomiase repose sur le traitement spécifique et un traitement antiparasitaire. Schistosomiasis associated pulmonary arterial hypertension belongs to group 1 of the pulmonary hypertension classification and should be considered in any patient with pulmonary hypertension returning from an endemic area. A 17-year-old patient was hospitalized for pulmonary hypertension detected during the initial assessment of viral hepatitis B-related cirrhosis with portal hypertension. The initial assessment established the diagnosis of pulmonary hypertension secondary to viral hepatitis B-cirrhosis. The patient's hepatic and haemodynamic condition deteriorated and he was treated with intravenous epoprostenol. This allowed subsequent performance of a liver transplantation. Epoprostenol could then be discontinued. Unexpectedly, histology of the liver explant revealed florid schistosomiasis in addition to hepatitis B cirrhosis. The diagnosis of pulmonary arterial hypertension associated with schistosomiasis may be difficult. It is necessary to repeat the serological studies and, sometimes, to obtain a rectal biopsy. The treatment of pulmonary arterial hypertension associated with schistosomiasis is based on specific therapies and antiparasitic treatment.
Publisher:
Elsevier Masson SAS
Language:
French
Identifier:
ISSN: 0761-8425
DOI: 10.1016/j.rmr.2018.11.004
Source:
Alma/SFX Local Collection
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