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BMJ Case Reports 2018; doi:10.1136/bcr-2017-222946
  • Unusual association of diseases/symptoms
  • CASE REPORT

Budd-Chiari syndrome: a rare and life-threatening complication of Crohn’s disease

Open AccessEditor's Choice
  1. Heather L Stevenson1
  1. 1 Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
  2. 2 Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
  1. Correspondence to Dr Heather L Stevenson, hlsteven{at}utmb.edu
  • Accepted 28 December 2017
  • Published 17 January 2018

Summary

Budd-Chiari syndrome (BCS) is characterised by obstruction of hepatic venous outflow and may be triggered by the prothrombotic state associated with inflammatory bowel disease (IBD). We reported a case of Crohn’s disease (CD) that presented with anasarca, ascites, symptomatic hepatomegaly, elevated liver enzymes, increased prothrombin time and low albumin. Oesophagogastroduodenoscopy and colonoscopy confirmed active CD. Abdominal CT showed hepatic vein thrombosis. Liver biopsy revealed severe perivenular sinusoidal dilation with areas of hepatocyte dropout, bands of hepatocyte atrophy and centrizonal fibrosis, suggestive of BCS. The patient was treated with steroids for CD and systemic anticoagulants for BCS. His liver function and enzymes normalised, and he reported symptomatic improvement. The precise mechanism responsible for increased hypercoagulability in IBD remains unclear. Early recognition and treatment for possible thrombotic complications of CD is critical to prevent potentially fatal events like pulmonary embolism or liver failure.

Footnotes

  • CCS and YAG contributed equally.

  • Contributors YAG and SNM are the physicians who evaluated and treated the patient. YAG and CCS formulated the initial draft of the manuscript. HLS made the diagnosis of Budd-Chiari on the liver biopsy, edited the manuscript and directed the overall project.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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