Recurrent intracranial hemorrhagic episodes in hepatopulmonary syndrome

A 57-year-old woman with hepatopulmonary syndrome was treated for eight years. Severe hypoxemia continued and her erythrocytosis was slowly progressive. Two episodes of intracranial hemorrhagic attack had occurred during the follow-up period and the patient died due to multiple organ failure after the second intracranial hemorrhage. Her autopsy findings confirmed not only established liver cirrhosis associated with intracranial hemorrhage but also the marked dilatation of pulmonary capillaries in both lungs. These findings suggest that secondary erythrocytosis in hepatopulmonary syndrome can be contributed to fatal intracranial vascular accidents. The containment of erythrocytosis should be considered in these patients.