Hakan ÜNAL, Derya UÇMAK, Murat KORKMAZ, Feyzullah UÇMAK, Haldun SELÇUK, Uğur YILMAZ

Lichenoid eruption occurring during chronic hepatitis C treatment with interferon-alpha 2-b plus ribavirin

Hepatosellüler karsinoma kanamaları, hepatosellüler kanserlerde en sık üçüncü mortalite nedenidir. Tanı ve tedavi güçlükleri hekimleri zor du- rumda bırakabilmektedir. Kırkdokuz yaşında hepatit B’ye bağlı siroz olan erkek hasta iki gündür devam eden sağ üst kadranda künt karın ağrısı nedeniyle hastaneye başvurdu. ‹lk muayenede hastanın taşikardi- si, hipotansiyonu ve karında distansiyonu gözlendi. Laboratuvar incele- mede bilirubin 8.2 mg/dL, albumin 2 g/dL geldi. Abdominal tomografi- de daha önce bilinmeyen 5x6 cm kitle ve batın içinde hemorajik mayi izlendi. Parasentezde hemorajik mayi gelmesi ve hastada şok tablosu gelişmesi üzerine hasta acil operasyona alındı. Operasyonda karaciğer segment 6’daki kitledeki kanama sütür yardımıyla durduruldu. Postope- ratif dönemde kanaması olamayan hasta 5. gün karaciğer yetmezliğin- den kaybedildi. Daha önceden tümörün varlığının bilinmemesi, tanısal zorluklar, karaciğer yetmezliği, hemorajik şok varlığı, atipik bulgular ve koagülasyon bozuklukları mortaliteyi artıran bulgulardır. Bu hastalarda konservatif tedavi, transarteriyal kemo embolizasyon, cerrahi gibi teda- vi yöntemleri uygun hastalara göre uygulanmalıdır. Siroz hastalarının takibinde tümör kanamaları için risk faktörleri de değerlendirilmelidir.

İnterferon alfa 2-b ve ribavirin ile tedavi edilen kronik hepatit C’li hastada gelişen likenoid döküntüler

Bleeding from hepatocellular carcinoma is the third leading cause of mortality in hepatocellular carcinoma. Difficulties in diagnosis and tre- atment represent the greatest challenges. A 49-year-old man with cirr- hosis due to hepatitis B virus had admitted to the hospital because of abdominal pain lasting for two days. The patient had tachycardia and hypotension, and abdominal distension. The levels of bilirubin and al- bumin were 8.2 mg/dl and 2 g/dl, respectively. The abdominal tomog- raphy revealed a 5x6 cm mass and hemorrhagic fluid. In the paracen- tesis, hemorrhagic fluid was aspirated. The patient underwent emer- gency surgery because of the hemorrhagic paracentesis fluid and exis- ting shock. Bleeding from the mass in the 6th segment of the liver was controlled by suturing. The bleeding stopped, but the patient died on the 5th day due to liver insufficiency. Diagnostic difficulties, liver insuf- ficiency, hemorrhagic shock, coagulation problems, and unknown masses are the risk factors for increasing mortality. Risk factors for bleedings should be evaluated during the follow-up of patients with cirrhosis.

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