Clinical medicine (London, England)
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Hepatopulmonary syndrome (HPS) is often not considered as a cause of breathlessness in patients with liver cirrhosis. It consists of a triad of liver disease, intrapulmonary shunting and hypoxaemia. Here we discuss HPS in a patient presenting with acute on chronic breathlessness and typical features of orthodeoxia and platypnoea. Evidence of intrapulmonary shunting on imaging was essential to making the diagnosis, which carries a poor prognosis and was an urgent indication for liver transplantation.
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Case Reports
Lesson of the month 2: Fever, arthralgias and hyperkeratotic, scaling and fissuring eruptions of the hands.
A 56-year-old male hairdresser, presented with fever and arthralgias. He had a worsening 'eczematous' palmar rash which had been attributed to irritation from colouring products used in his work. On examination, hyperkeratotic, fissuring eruptions were noted on the palmar side of his fingers and lung auscultation revealed crackles on both lower lobes. ⋯ This is a characteristic semiology reminiscent of hands of manual workers, resembling hand eczema. 'Mechanic's hands', fever, arthralgias, lung findings and elevated serum muscle enzymes raised the possibility of antisynthetase syndrome. Testing for myositis autoantibodies revealed anti-Jo-1 and anti-Ro52 reactivity supporting the diagnosis. Greater awareness of the typical clinical feature of 'mechanic's hands' will allow for earlier diagnosis and appropriate treatment in patients with antisynthetase syndrome.