Chen Y, Kong BB, Yin H, Liu H, Wu S, Xu T. Acute upper gastrointestinal bleeding due to portal hypertension in a patient with primary myelofibrosis: A case report. World J Clin Cases 2024; 12(15): 2621-2626 [PMID: 38817215 DOI: 10.12998/wjcc.v12.i15.2621]
Corresponding Author of This Article
Ting Xu, MD, Doctor, Department of Emergency, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Changping District, Beijing 102218, China. xta01392@btch.edu.cn
Research Domain of This Article
Emergency Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yu Chen, Bing-Bing Kong, He Yin, Sheng Wu, Ting Xu, Department of Emergency, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
Hao Liu, Department of Pathology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
Author contributions: Chen Y and Xu T designed the research; Wu S and Xu T performed the research; Liu H contributed new analytic tools; Kong BB and Yin H analyzed the data; Chen Y and Xu T wrote the paper.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We declare that we have no financial and personal relationships with other people ororganizations that can inappropriately influence our work, there is no professional or other personal interest of anynature or kind in any product, service and/or company that could be construed as influencing the position presentedin, or the review of, the manuscript entitled.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ting Xu, MD, Doctor, Department of Emergency, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Changping District, Beijing 102218, China. xta01392@btch.edu.cn
Received: January 21, 2024 Revised: February 10, 2024 Accepted: April 7, 2024 Published online: May 26, 2024 Processing time: 113 Days and 18.6 Hours
Abstract
BACKGROUND
Acute upper gastrointestinal bleeding is a common medical emergency that has a 10% hospital mortality rate. According to the etiology, this disease can be divided into acute varicose veins and nonvaricose veins. Bleeding from esophageal varices is a life-threatening complication of portal hypertension. Portal hypertension is a clinical syndrome defined as a portal venous pressure that exceeds 10 mmHg. Cirrhosis is the most common cause of portal hypertension, and thrombosis of the portal system not associated with liver cirrhosis is the second most common cause of portal hypertension in the Western world. Primary myeloproliferative disorders are the main cause of portal venous thrombosis, and somatic mutations in the Janus kinase 2 gene (JAK2 V617F) can be found in approximately 90% of polycythemia vera, 50% of essential thrombocyrosis and 50% of primary myelofibrosis.
CASE SUMMARY
We present a rare case of primary myelofibrosis with gastrointestinal bleeding as the primary manifestation that presented as portal-superior-splenic mesenteric vein thrombosis. Peripheral blood tests revealed the presence of the JAK2 V617F mutation. Bone marrow biopsy ultimately confirmed the diagnosis of myelofibrosis (MF-2 grade).
CONCLUSION
In patients with acute esophageal variceal bleeding due to portal hypertension and vein thrombosis without cirrhosis, the possibility of myeloproliferative neoplasms should be considered, and the JAK2 mutation test should be performed.
Core Tip: Emergency physicians often encounter patients with acute esophageal variceal bleeding and portal vein thrombosis. We hope that this case report can increase the awareness that in patients who present with variceal bleeding without liver cirrhosis, myeloproliferative neoplasms such as myelofibrosis with the JAK2 V617F mutant, can be identified and treated early to minimize the consequences and avoid bleeding.
