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December 1969

The Budd-Chiari Syndrome Caused By Aspergillus: Two Patients With Vascular Invasion of the Hepatic Veins

Author Affiliations

Bethesda, Md

From the Solid Tumor Service, Medicine Branch, National Cancer Institute, Bethesda, Md.

Arch Intern Med. 1969;124(6):754-757. doi:10.1001/archinte.1969.00300220106020

The Budd-Chiari syndrome following hepatic vein occlusion is a symptom complex characterized by ascites, abdominal pain, hepatosplenomegaly distended superficial veins, and variable jaundice. Numerous causes of this relatively rare phenomenon have been reported, and several extensive reviews are available.1-3 Polycythemia vera, hypernephroma, and primary tumors of the inferior vena cava are the most frequently reported causes, but approximately 70% of the cases remain idiopathic.1

To our knowledge, vascular invasion of the hepatic veins by Aspergillus is an unusual and previously unreported cause of Budd-Chiari syndrome. Masses of fungal hyphae filled the vessels, which resulted in thrombosis and initiated the syndrome.

Patient Summaries 

Patient 1 (05-99-43).  —A 4½-year-old girl had acute lymphocytic leukemia diagnosed in January 1965. Remission was induced with combination chemotherapy (vincristine sulfate, methotrexate, mercaptopurine, and prednisone) and the remission was maintained with monthly courses of this combination. Successive relapses were treated with various protocol combinations