Budd–Chiari syndrome at the cirrhosis stage: A case report from Campus Teaching Hospital of Lome-Togo

Abstract

Budd–Chiari syndrome is a rare disease and is a significant cause of cirrhosis. We report a clinical case of a 23-yearold patient,  highlighting  the diagnostic and therapeutic difficulties of Budd–Chiari syndrome at the cirrhosis stage in a country with limited resources  such as Togo. A 23-year-old, nonalcoholic, patient who tested negative for hepatitis B and C virus presented with progressive abdominal  distension. Examination revealed grade 2 ascites and soft, painless, cold, bucketing edema of the lower limbs rising to the knees. The  calculated serum-ascites albumin gradient was 12g/L. Abdominal ultrasound and abdominal computed tomography  indicated the presence of thrombosis of the inferior vena cava, which ascended to the hepatic veins. Biological signs of hepatocellular insufficiency such as a low prothrombin time (56%) and low serum albumin levels (22g/L) with a beta-gamma block were also found.  Upper gastrointestinal endoscopy revealed grade 3 esophageal varices with red signs. The diagnosis of Budd–Chiari syndrome at the  stage of cirrhosis classified as Child–Pugh score 9 decompensated in the ascitic mode, complicated by grade 3 esophageal varices with  red signs, was retained. Due to the inadequacy of the technical facilities in Togo, and also because of financial difficulties, aetiological  work-up was not carried out. Anticoagulant treatment with rivaroxaban 10mg/day has been instituted. The clinical outcomes were poor with gastrointestinal bleeding, stage 3 hepatic encephalopathy, and death on the 46th day. The prognosis of Budd–Chiari syndrome is  poor in resource-limited countries such as Togo. It depends on the quality of care, not only of the etiology but also of the complications of  cirrhosis.