Endocrine Abstracts

Background: Budd-Chiari syndrome, characterized by abdominal pain, ascites and hepatomegaly, is a rare condition, caused by thrombotic hepatic venous outflow obstruction. Diabetes mellitus is associated with impairment of the coagulation and fibrinolysis pathway, suggesting its involvement in the pathogenesis of venous thromboembolism. There are few cases of patients with Budd-Chiari syndrome and Diabetes Mellitus, reported in the literature.

Case presentation: A 30-year-old woman presented in the Emergency Department because of nausea and abdominal discomfort developed the last 25 days. She used tobacco, was not pregnant, did not use oral contraceptives, without family history of thrombotic episodes. She had type 1 Diabetes mellitus since the age of ten, treated with insulin degludec and insulin aspart. Routine laboratory tests showed mild elevation of liver enzymes and poor glycemic control (HbA1c 8%). Abdominal ultrasonography revealed moderate ascites. Computed tomography and Magnetic Resonance Angiography showed ascitic fluid, hepatomegaly, heterogeneity of liver parenchyma, enlarged caudate lobe and absence of blood flow in hepatic veins, indicating the presence of acute-subacute Budd-Chiari syndrome. The patient was heterozygous for MTHFR mutations and had positive anti-β2 glycoprotein-I IgM antibodies in two consecutive tests, but not in the third, without other pathological findings.

Conclusions: During the diagnostic approach, not any known cause of Budd-Chiari syndrome was identified. Neither hyperhomocysteinemia nor antiphospholipid syndrome was overt in this patient. We conclude that there is a potential association between the hypercoagulable state of Diabetes mellitus and hepatic vein thrombosis, which should be further investigated.