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Case Reports
. 2018 Jul 3;11(1):436.
doi: 10.1186/s13104-018-3533-0.

Fulminant hepatitis due to very severe sinusoidal obstruction syndrome (SOS/VOD) after autologous peripheral stem cell transplantation: a case report

Emmanuelle Tavernier  1 , Emilie Chalayer  2 , Jérôme Cornillon  2 , Anne Pouvaret  2 , Jean-Alain Martignoles  2 , François Casteillo  3 , Jérémy Terreaux  4 , Elisabeth Daguenet  2 , Denis Guyotat  2
Affiliations
Case Reports

Fulminant hepatitis due to very severe sinusoidal obstruction syndrome (SOS/VOD) after autologous peripheral stem cell transplantation: a case report

Emmanuelle Tavernier et al. BMC Res Notes. .

Abstract

Background: Hepatic veno-occlusive disease, also called sinusoidal obstruction syndrome (SOS/VOD), is a potentially fatal complication of allogeneic or autologous hematopoietic stem cell transplantation. A plethora of transplant and patient-related risk factors predispose to SOS/VOD and should be taken into account for prognosis assessment as well as for adequate therapeutic intervention.

Case presentation: We describe the case of a mantle cell lymphoma patient who developed a fulminant hepatitis following oxaliplatin-containing intensive chemotherapy and autologous transplantation. This clinical manifestation was secondary to a very severe SOS/VOD. The patient did not exhibit the usual risk factors and presented a non-classical form with major cytolysis, thus puzzling SOS/VOD diagnosis in this context.

Conclusion: SOS has been previously reported after oxaliplatin-based chemotherapy regimens for colorectal cancers, in particular in patients with colorectal liver metastases. We therefore suspected a potential relationship with oxaliplatin-based regimen as a driver of SOS/VOD in a non-susceptible lymphoma patient. With regards to this case, clinicians and especially intensivists should be aware of this atypical presentation.

Keywords: Autologous transplantation; BEAM regimen; Case report; Mantle cell lymphoma; Oxaliplatin; Sinusoidal obstruction syndrome.

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Figures

Fig. 1
Fig. 1
Laboratory data during the clinical course from Day −7 (D −7) to Day +16 (D +16): hepatic enzymes with AST, ALT and total bilirubin. The reference day corresponds to the autologous transplantation (Day 0, depicted with the arrow 1). Defibrotide treatment was initiated on Day +9 in the evening (D +9PM, depicted with the arrow 2)
Fig. 2
Fig. 2
Laboratory data during the clinical course from Day −7 (D −7) to Day +16 (D +16): coagulation factor with Factor V and INR
Fig. 3
Fig. 3
Microscopic finding of the liver biopsy. Veinous dilatation and congestion in veno-occlusive disease with fibrosis and sub-intimal oedema (trichrome stain, ×200)
See this image and copyright information in PMC

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References

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