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• W3093870280 abstract "INTRODUCTION: Budd-Chiari syndrome (BCS) is an uncommon condition that is characterized by obstruction of hepatic venous outflow from the hepatic venules to the junction of inferior vena cava (IVC) and right atrium. Patients with this syndrome present similarly to those with hepatic disease and complain typically of vomiting, abdominal pain, ascites, jaundice, hepatomegaly, and encephalopathy. Hypercoagulable states are usually the primary cause of BCS. Here, we present a rare cause of BCS. CASE DESCRIPTION/METHODS: A 49-year-old male with no past medical history presents to his primary care physician with nausea, vomiting, abdominal pain, abdominal distention, and lower extremity edema for 2 months. Travel history was notable for a trip to Bangladesh 7 months prior to presentation. Outpatient CT of the abdomen and pelvis with contrast demonstrated thrombosis of the IVC, suggestive of Budd-Chiari syndrome. The patient was directly admitted to the hospital, where an absolute eosinophil count of 5,360 was found. Paracentesis demonstrated 3.5L of red, cloudy peritoneal fluid with significant eosinophilia and a SAAG suggestive of portal hypertension. Given eosinophilia, stool ova and parasite screen was ordered, which ultimately demonstrated Dientamoeba fragilis trophozoites. Treatment was initiated with metronidazole and enoxaparin, which was bridged to warfarin. At the one-month follow up appointment, the patient had resolution of IVC thrombosis and symptoms. DISCUSSION: Dientamoeba fragilis is a flagellate that is closely related to trichomonads. D. fragilis trophozoites are found in the lumen of the colon, where they multiply by binary fission and are shed into the stool. While there are rare cases of parasitic infections causing BCS, the authors cannot find another case from the literature that involves D. fragilis as the causative species. The mechanism of thrombosis in this patient is suspected to be peripheral blood eosinophilia. Eosinophils have a collection of proteins named major basic protein, eosinophilic cationic protein, and eosinophil peroxidase. These proteins are known to induce a hypercoagulable state by depressing fibrinolysis, stimulating platelets to release PF4, and encouraging endothelial cellular exposure of tissue factor. Eosinophils have also been demonstrated to express additional tissue factor, which can activate the coagulation pathway via factor VII and X. This case demonstrates the importance of having parasitic infections on the differential as a cause of BCS with eosinophilia." @default.
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• W3093870280 date "2020-10-01" @default.
• W3093870280 modified "2023-10-16" @default.
• W3093870280 title "S2479 A Rare Culprit in a Case of Budd-Chiari Syndrome" @default.
• W3093870280 doi "https://doi.org/10.14309/01.ajg.0000711964.34754.dd" @default.
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