Pulmonary hypertension in hepatitis B virus carriers

Area of Science:

• Cardiology
• Hepatology
• Pathology

Background:

• Liver cirrhosis is a significant health concern, often associated with various complications.
• Pulmonary hypertension (PH) is a severe condition characterized by high blood pressure in the pulmonary arteries.
• Hepatitis B virus (HBV) infection is a leading cause of liver cirrhosis worldwide.

Observation:

• Two autopsy cases of pulmonary hypertension in patients with liver cirrhosis are presented.
• Both patients were carriers of the hepatitis B virus and had type B cirrhosis.
• Clinical and autopsy findings revealed significant pulmonary arterial changes, including dilatation, sclerosis, intimal fibrosis, medial hypertrophy, and plexiform lesions.

Findings:

• Autopsy confirmed right ventricular hypertrophy in both patients, indicating strain on the heart due to PH.
• Histopathological examination showed advanced pulmonary arteriopathy, including plexiform lesions and necrotizing arteritis in one case.
• Hepatitis B surface antigen (HBsAg) was detected in both liver cells and pulmonary arterial walls, suggesting viral involvement.

Implications:

• The findings suggest a potential association between persistent hepatitis B viral infection and the development of pulmonary hypertension in the context of liver cirrhosis.
• This highlights the importance of considering PH in HBV-related cirrhosis patients, even with atypical presentations.
• Further research is warranted to elucidate the precise mechanisms linking HBV infection, liver cirrhosis, and pulmonary hypertension.