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A Rare Association between Left Lobe Secondary Biliary Cirrhosis and Budd-Chiari Syndrome Secondary to Hepatocellular Carcinoma in the Non-Cirrhotic Right Liver Lobe
Andreea Fodor1, Ana-Maria Fit2, Oana Farcau1, Ioana Rusu2, Horia Stefanescu3, Bogdan Procopet1,3

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1) Iuliu Hatieganu University of Medicine and Pharmacy, Department of Internal Medicine, 3rd Medical Clinic;
2) Pathology Department, and
3) Hepatology Unit, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.264.cri

ABSTRACT
Liver cirrhosis is a diffuse chronic liver disease affecting the entire liver. The fibrosis accumulation and distribution in the liver are known to be heterogeneous. „Localized” or „focal” cirrhosis is only anecdotically reported. Acute hepatitis E virus (HEV) infection is uncommon in western countries, especially in temperate climate areas and is very often missed or underdiagnosed. However, it may be responsible of up to 15% of acute-on-chronic liver failure cases. We present the case of a 35-year-old patient with a very uncommon association of Budd-Chiari syndrome secondary to hepatocellular carcinoma (HCC) developed on a non-cirrhotic right liver lobe and secondary biliary cirrhosis of the left liver lobe, that further complicated with acute HEV infection leading to acute-on-chronic liver failure and death.
Key words: autochthonous HEV infection − single liver lobe cirrhosis − secondary biliary cirrhosis − secondary Budd-Chiari syndrome − hepatocellular carcinoma.
Abbreviations: Alb: Albumin; AFP: alpha feto-protein; ALP: alkaline phosphatase; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BCS: Budd-Chiari syndrome; CK7: cytokeratin 7; CMV: cytomegalovirus; EBV: Epstein-Barr virus; GGT: gamma glutamyl transpeptidase; HBV: hepatitis B virus; HCV: hepatitis C virus; HEV: hepatitis E virus; HSV: hepes simplex virus; HCC: hepatocellular carcinoma; IVC: inferior vena cava; MELD: model for end-stage liver disease; (MD)CT: (multi-detector) computer tomography; PT: prothrombin time; TB: total bilirubin.