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Nodular regenerative hyperplasia, portal vein thrombosis, and avascular hip necrosis due to hyperhomocysteinaemia

¹ Division of Hepato-biliary and Pancreas Diseases, University Hospital Gasthuisberg, Leuven, Belgium
² Department of Pathology, University Hospital Gasthuisberg, Leuven, Belgium
³ Division of Abdominal Transplant Surgery, University Hospital Gasthuisberg, Leuven, Belgium

Correspondence to:
Correspondence to:
Professor J Fevery
University Hospital Gasthuisberg, Leuven, B 3000 Belgium; Johan.Fevery{at}uz.kuleuven.ac.be

ABSTRACT
A male patient with portal hypertension, portal vein thrombosis, spontaneous splenorenal shunt formation, and encephalopathy, thought to have post-hepatitis B cirrhosis, is described. His condition deteriorated and necessitated liver transplantation. In the explant liver, nodular regenerative hyperplasia with pronounced vascular lesions both in portal venules and in arterioles was found instead of classical cirrhosis. Two years post-transplant he developed bilateral ischaemic femur head necrosis. The three disorders (portal vein thrombosis, nodular regenerative hyperplasia, and ischaemic hip necrosis) seemed to be due to a common vasculopathy induced by hyperhomocyteinaemia. Genetic studies showed that he carried a mutation in the gene encoding for formation of methylenetetrahydrofolate reductase. Treatment with folic acid combined with pyridoxine (vitamin B6) and cyanocobalamin (vitamin B12) normalised his serum homocysteine levels.

Keywords: homocystein; nodular regenerative hyperplasia; portal vein thrombosis; avascular hip necrosis; portal hypertension; osteopenia

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Hyperhomocysteinaemia and vascular disease in liver patients

G Bianchi, G Marchesini, and M Zoli
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