A case of suspected portal-pulmonary hypertension due to hepatitis C virus infection

A 44-year-old woman with chronic hepatitis C virus (HCV) infection was referred by a primary care doctor and admitted to our hospital because of worsening dyspnea on exertion and right atrial and ventricular enlargement. The patient was diagnosed with pulmonary arterial hypertension (PAH) associated with portal hypertension induced by chronic HCV infection. This diagnosis was based on a cardiological examination and findings related to liver cirrhosis with portal hypertension. After the prescription of anti-PAH medicine and a slight improvement in her respiratory symptoms, 12-week direct-acting antiviral (DAA) treatment for HCV was started. Serum HCV RNA levels rapidly decreased and HCV elimination was confirmed 24 weeks after completing DAA treatment. Before confirmation of a sustained virological response at 24 weeks after completing DAA treatment, a remarkable improvement in her cardiac markers was found in a right heart catheter study. This study was performed 6 weeks after the end of DAA administration. Therefore, we considered that HCV infection was involved in the development of PAH and that elimination of HCV by interferon-free treatment was important for this patient.