Can this be considered as a case of Budd-Chiari syndrome?
A 32 years old woman was hospitalized in a public hospital with the following complaints: ascites, dyspnea after exercise, and the development of veins and edema in the abdominal wall and swelling in the legs. Five years earlier, she had developed asymmetric recurrent migratory arthritis in her wrists and ankles, moderate and intermittent fever, recurrent painful ulcers and lesions in the oral cavity and vagina, and painful transient erythema nodosum on her forearm and legs. She reported light smoking and moderate alcoholism. She denied abortion, use of oral contraceptives and a pathological family history.
Physical examination showed that the patient had mild dyspnea, jaundice, pale skin, absence of fever, adenopathy, acneiform eruptions on the face and trunk, reduced vesicular murmur at right lung base, ascites with varicose veins in the abdomen near the skin surface, an enlarged and tender liver and edema of legs. She developed a rapid increase in the abdominal volume, abdominal pain, and dyspnea after exercise and onset of jugular turgescence.
Laboratory tests detected hypochromic and microcytic anemia; nonreactive viral hepatitis serology; nonreactive HIV and syphilis infection serology; negative autoantibodies; undetected rheumatoid factor and serum complement; normal levels of protein C, S, and antithrombin-II; high haemo sedimentation velocity and C-reactive protein; serum ascites albumin gradient greater than 1.1; normal indirect binocular ophthalmoscopy; and a positive skin pathergy test. The chest radiograph showed pleural effusion.An echocardiogram showed no pulmonary hypertension but mild systolic deficit by diffuse hypokinesia of the left ventricle, pulmonary artery pressure of 25 mm Hg, ejection fraction of 40% and mild pericardial effusion. Doppler ultrasound examination of suprahepatic and cava veins showed an absence of flow in the left suprahepatic vein.