Severe Hypoxemia in a Young Patient: Unusual Presentation of Cryptogenic Cirrhosis with Hepatopulmonary Syndrome

1 liver disease.One study found 48.96% prevalence in 2 advanced cirrhosis.In Pakistan, HPS has been found in 26% to 29% of cirrhotic patients.It results from intrapulmonary vascular dilatations leading to right-3 to-left shunting and impaired oxygenation.It often presents with clubbing, cyanosis, platypnea, and 4 dyspnea.The diagnosis is clinical, radiological, and echocardiographic -often requiring a high index of 5 suspicion.HPS incidence correlate with Child-Pugh score and MELD score.A previous study revealed no significant relationship between mortality and HPS when adjustments were made for the severity of liver 4 disease.However, other studies have found out increased mortality related to HPS and stressed the 3,6use of MELD exception points for such patients.HPS was also identified as an independent predictor of mortality; in addition to age, Child-Pugh scoring and renal dysfunction.Liver transplantation is currently the only curative option and complete resolution of symptoms is seen in all patients after 1 1,7 year.Despite several challenges, outcomes of liver 8 transplant are improving in Pakistan.Cryptogenic cirrhosis is a diagnosis of exclusion and also contributes to morbidity and mortality.We present a case of HPS in a young woman with no known history of liver disease who presented primarily with respiratory complaints. Case PresentationA 35-year-old married woman having two kids, no abortions, presented with bluish discoloration of her fingertips for two weeks.She had also reported progressive exertional dyspnea and fatigue upon inquiry.She denied all other respiratory and cardiac symptoms, including orthopnea, PND, cough, and chest tightness.She had no significant past medical