Hepatopulmonary Syndrome as First Presentation of Liver Cirrhosis

A 46-year-old male nonsmoker presented to the outpatient department (OPD) with a history of progressively increasing breathlessness and central cyanosis since 1 month. He had a history of surgery for craniopharyngioma 6 years back and was on hormone replacement therapy. On evaluation, no cardiopulmonary cause was found for cyanosis. Patient was detected to have cirrhosis, possibly due to nonalcoholic fatty liver disease (NAFLD), and hepatopulmonary syndrome (HPS) was suspected as the cause for dyspnea and cyanosis, which was confirmed on workup. HPS as the first presentation of undiagnosed cirrhosis is relatively rare, although there are some case reports in the literature.