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Case Reports
. 2023 Apr 20;10(4):e01038.
doi: 10.14309/crj.0000000000001038. eCollection 2023 Apr.

Cemiplimab-Associated Sinusoidal Obstruction Syndrome

Nadeen Y Sarsour  1 , Marta Minervini  2 , Shahid M Malik  3
Affiliations
Case Reports

Cemiplimab-Associated Sinusoidal Obstruction Syndrome

Nadeen Y Sarsour et al. ACG Case Rep J. .

Abstract

A 58-year-old woman developed new-onset recurrent ascites after the recent initiation of cemiplimab for the treatment of advanced basal cell carcinoma. A comprehensive serological workup for viral, metabolic, and autoimmune causes was unrevealing. Transjugular liver biopsy demonstrated parenchymal changes consistent with a diagnosis of sinusoidal obstruction syndrome. While this is a condition commonly observed in patients after hematopoietic stem cell transplantation or use of chemotherapeutic agents, it should also be considered in patients who develop new-onset liver dysfunction after the initiation of checkpoint inhibitors.

Keywords: cemiplimab; check-point inhibitor; nodular regenerative hyperplasia; sinusoidal obstruction syndrome; veno-occlusive disease.

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Figures

Figure 1.
Figure 1.
Moderate nodular regenerative hyperplasia of previously normal hepatic parenchyma.
Figure 2.
Figure 2.
Prominent central vein sclerosis with fibrous obliteration.
Figure 3.
Figure 3.
Centrizonal sclerosis with ceroid-laden macrophages. Ceroid-laden macrophages are a well-recognized pathologic feature of liver injury commonly seen in autoimmune drug-induced liver injury. Ceroid contains modified lipoproteins (such as malondialdehyde-modified low-density lipoprotein), which are generated as a consequence of chronic oxidative stress.
Figure 4.
Figure 4.
Elastic trichrome with centrizonal sclerosis.
See this image and copyright information in PMC

References

    1. Bonifazi F, Barbato F, Ravaioli F, et al. . Diagnosis and treatment of VOD/SOS after allogeneic hematopoietic stem cell transplantation. Front Immunol. 2020;11:489. - PMC - PubMed
    1. DeLeve LD, Wang X, Kuhlenkamp JF, Kaplowitz N. Toxicity of azathioprine and monocrotaline in murine sinusoidal endothelial cells and hepatocytes: The role of glutathione and relevance to hepatic venoocclusive disease. Hepatology. 1996;23(3):589–99. - PubMed
    1. Fuste B, Escolar G, Marin P, Mazzara R, Ordinas A, Diaz-Ricart M. G-CSF increases the expression of VCAM-1 on stromal cells promoting the adhesion of CD34+ hematopoietic cells: Studies under flow conditions. Exp Hematol. 2004;32(8):765–72. - PubMed
    1. Mercanoglu F, Turkmen A, Kocaman O, et al. . Endothelial dysfunction in renal transplant patients is closely related to serum cyclosporine levels. Transpl Proc. 2004;36(5):1357–60. - PubMed
    1. Zoja C, Furci L, Ghilardi F, Zilio P, Benigni A, Remuzzi G. Cyclosporin-induced endothelial cell injury. Lab Invest. 1986;55(4):455–62. - PubMed

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