{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:57:18Z","timestamp":1791219438254,"version":"4.1.0"},"reference-count":14,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,9,20]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>A previously well man in his 20s presented with fever, cough, new-onset jaundice and a right-sided pleural effusion. Initial investigations demonstrated marked hepatic synthetic dysfunction. Subsequent imaging demonstrated cirrhotic liver morphology with splenomegaly and ascites. Additional findings of gallbladder wall oedema and focal colonic wall thickening broadened the differentials but following specialist radiology review, these abnormalities were recognised as manifestations of portal hypertension rather than separate disease processes.<\/jats:p>\n                  <jats:p>\n                    Further investigations confirmed Wilson\u2019s disease including Kayser-Fleischer rings, low serum caeruloplasmin, MRI brain consistent with Wilson\u2019s disease, copper deposition on liver biopsy and confirmatory\n                    <jats:italic>ATP7B<\/jats:italic>\n                    genetic testing. Following multidisciplinary discussion, penicillamine therapy was commenced with subsequent clinical and biochemical improvement.\n                  <\/jats:p>\n                  <jats:p>This case highlights the importance of interpreting radiological findings alongside the clinical presentation and biochemical context, recognising portal hypertension as a unifying explanation for multisystem imaging abnormalities and considering Wilson\u2019s disease in young adults presenting with otherwise unexplained hepatic synthetic dysfunction.<\/jats:p>","DOI":"10.1136\/bcr-2026-274381","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:10:20Z","timestamp":1791216620000},"page":"e274381","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Multisystem imaging findings as diagnostic red herrings in Wilson\u2019s disease"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8576-3532","authenticated-orcid":false,"given":"Lujain","family":"Hassan","sequence":"first","affiliation":[{"name":"Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2071-7749","authenticated-orcid":false,"given":"Esther","family":"Sleigh","sequence":"additional","affiliation":[{"name":"Hepatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9633-7422","authenticated-orcid":false,"given":"Alisha","family":"Giby","sequence":"additional","affiliation":[{"name":"Hepatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5734-239X","authenticated-orcid":false,"given":"Shaies Zahoor","family":"Chat","sequence":"additional","affiliation":[{"name":"Hepatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadeem","family":"Tehami","sequence":"additional","affiliation":[{"name":"Hepatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"2026100509101138000_19.10.e274381.1","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1016\/j.jhep.2024.11.007","article-title":"EASL-ERN Clinical Practice Guidelines on Wilson\u2019s disease","volume":"82","author":"Socha","year":"2025","journal-title":"J Hepatol"},{"key":"2026100509101138000_19.10.e274381.2","unstructured":"Bacon BR , disease GSW . American college of gastroenterology. Available: https:\/\/gi.org\/topics\/wilson-disease\/?utm_source=chatgpt.com [Accessed 14 Mar 2026]."},{"key":"2026100509101138000_19.10.e274381.3","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0676.2003.00824.x"},{"key":"2026100509101138000_19.10.e274381.4","doi-asserted-by":"crossref","first-page":"4804","DOI":"10.1016\/j.radcr.2022.09.046","article-title":"Portal hypertensive enteropathy: multimodality assessment through computed tomography and magnetic resonance enterography","volume":"17","author":"Cicero","year":"2022","journal-title":"Radiol Case Rep"},{"key":"2026100509101138000_19.10.e274381.5","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1055\/s-0030-1269829","article-title":"Pleural Effusion in Liver Disease","volume":"31","author":"Alonso","year":"2010","journal-title":"Semin Respir Crit Care Med"},{"key":"2026100509101138000_19.10.e274381.6","article-title":"Unmasking Portal Colopathy: A Case of Rectal Bleeding in a Patient With Liver Cirrhosis Misdiagnosed as Ulcerative Colitis","volume":"17","author":"Ghosh","year":"2025","journal-title":"Cureus"},{"key":"2026100509101138000_19.10.e274381.7","doi-asserted-by":"publisher","DOI":"10.1259\/0007-1285-63-756-922"},{"key":"2026100509101138000_19.10.e274381.8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1303712"},{"key":"2026100509101138000_19.10.e274381.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2012.04.005"},{"key":"2026100509101138000_19.10.e274381.10","unstructured":"Knipe H . Wilson disease (CNS manifestations). Available: https:\/\/radiopaedia.org\/articles\/wilson-disease-cns-manifestations-1?lang=us [Accessed 8 Jun 2026]."},{"key":"2026100509101138000_19.10.e274381.11","doi-asserted-by":"crossref","DOI":"10.21037\/atm.2019.02.43","article-title":"Neurologic impairment in Wilson disease","volume":"7","author":"Dusek","year":"2019","journal-title":"Ann Transl Med"},{"key":"2026100509101138000_19.10.e274381.12","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2026.1770198","article-title":"Distinguishing anchoring from confirmation bias in diagnostic vignette studies: methodological implications for clinical decision-making","volume":"14","author":"Mart\u00ednez","year":"2026","journal-title":"Front Public Health"},{"key":"2026100509101138000_19.10.e274381.13","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1016\/S2468-1253(22)00004-8","article-title":"Investigation and management of Wilson\u2019s disease: a practical guide from the British Association for the Study of the Liver","volume":"7","author":"Shribman","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2026100509101138000_19.10.e274381.14","doi-asserted-by":"crossref","first-page":"101768","DOI":"10.1016\/j.bpg.2021.101768","article-title":"Wilson\u2019s disease- management and long term outcomes","volume":"56\u201357","author":"Socha","year":"2022","journal-title":"Best Pract Res Clin Gastroenterol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-274381","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:10:23Z","timestamp":1791216623000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-274381"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":14,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,5]]},"published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1136\/bcr-2026-274381"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-274381","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]}}}