Fatal liver mass rupture in a common-variable-immunodeficiency patient with probable nodular regenerating hyperplasia
Issued Date
2022-12-01
Resource Type
ISSN
17101484
eISSN
17101492
Scopus ID
2-s2.0-85122595890
Journal Title
Allergy, Asthma and Clinical Immunology
Volume
18
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
Allergy, Asthma and Clinical Immunology Vol.18 No.1 (2022)
Suggested Citation
Sompornrattanaphan M., Tongdee R., Wongsa C., Jitmuang A., Thongngarm T. Fatal liver mass rupture in a common-variable-immunodeficiency patient with probable nodular regenerating hyperplasia. Allergy, Asthma and Clinical Immunology Vol.18 No.1 (2022). doi:10.1186/s13223-021-00643-1 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/84869
Title
Fatal liver mass rupture in a common-variable-immunodeficiency patient with probable nodular regenerating hyperplasia
Author's Affiliation
Other Contributor(s)
Abstract
Background: Nodular regenerating hyperplasia (NRH) is the most common liver involvement in common variable immunodeficiency (CVID). Most patients are asymptomatic with gradually increasing alkaline phosphatase (ALP) and mildly elevated transaminase enzymes over the years. We report the first case of fatal liver mass rupture in a CVID patient with probable NRH. Case presentation: A 24-year-old man was diagnosed with CVID at the age of 1.25 years. Genetic testing revealed a transmembrane activator and calcium-modulator and cyclophilin-ligand interactor (TACI) mutation. He had been receiving intravenous immunoglobulin (IVIg) replacement therapy ever since then. The trough level of serum IgG ranged between 750–1200 mg/dL. However, he still had occasional episodes of lower respiratory tract infection until bronchiectasis developed. At 22 years old, computed tomography (CT) chest and abdomen as an investigation for lung infection revealed incidental findings of numerous nodular arterial-enhancing lesions in the liver and mild splenomegaly suggestive of NRH with portal hypertension. Seven months later, he developed sudden hypotension and tense bloody ascites. Emergency CT angiography of the abdomen showed NRH with intrahepatic hemorrhage and hemoperitoneum. Despite successful gel foam embolization, the patient died from prolonged shock and multiple organ failure. Conclusions: Although CVID patients with NRH are generally asymptomatic, late complications including portal hypertension, hepatic failure, and hepatic rupture could occur. Therefore, an evaluation of liver function should be included in the regular follow-up of CVID patients.