Title: Peliosis Hepatis In Marrow Transplant Patient: A Case Report
Abstract: Introduction: Peliosis hepatis (PH) is a rare condition defined by multiple blood-filled cysts in liver parenchyma. The etiology of PH remains unclear, however it has been associated with autoimmune mechanisms, malignancies and infections. Drugs including steroids have been associated as well. The presentation of PH is often non-specific, such as vague recurring abdominal pain. However it can also rarely have a potentially fatal presentation. Results: We report a case of a 22 year-old Malay man who came with acute onset of abdominal pain and hemorrhagic shock. He has a background of dyskeratosis congenita, which was complicated by bone marrow failure. He has undergone allogenic bone marrow transplant 2 years prior. Relevant history of note is patient's previous steroid therapy for immunosuppression post-marrow transplant which was completed 1 year ago. Computed tomography (CT) showed hemoperitoneum at time of presentation and widespread hepatic lesions, largest one measuring 8x5cm. On angiography, multiple blushes of contrast were seen with dilated vascular channels suggestive of PH. Angioembolization was done patient was resuscitated with blood products to good effect after. Conclusion: Peliosis hepatis is a condition that can be easily overlooked due to its rarity, and is potentially fatal. In patients with complex haematological issues, this is particularly dangerous as there may be increased risk of bleeding. PH should be considered in patients with relevant medical or drug history presenting with atypical widespread liver lesions seen on imaging.