Abstract
Sinusoidal obstruction syndrome (SOS) is a fatal complication after hematopoietic
stem cell transplantation (HSCT). Only a few complications after HSCT have been reported
as risk factors for SOS, including sepsis. Here, we report the case of a 35-year-old
male diagnosed with Philadelphia chromosome-positive acute lymphoblastic leukemia
who underwent peripheral blood HSCT from a human leukocyte antigen-matched unrelated
female donor in remission. Graft-versus-host disease prophylaxis contained tacrolimus,
methotrexate, and low-dose anti-thymoglobulin. The patient was treated with methylprednisolone
for engraftment syndrome from day 22. On day 53, he presented worsening fatigue, breathlessness,
and abdominal pain in the right upper quadrant that had persisted for 4 days. Laboratory
tests showed severe inflammation, liver dysfunction, and positive for Toxoplasma gondii PCR. He died on day 55. An autopsy showed SOS and disseminated toxoplasmosis. Hepatic
infection with T. gondii was identified in zone 3 of the liver, which overlapped with the pathological features
of SOS. In addition, the timing of the exacerbation of hepatic dysfunction coincided
with the onset of systemic inflammatory symptoms and T. gondii reactivation. This rare case of toxoplasmosis is the first to suggest that hepatic
infection with T. gondii is strongly associated with SOS after HSCT.
Keywords
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Article info
Publication history
Published online: May 19, 2023
Accepted:
May 10,
2023
Received in revised form:
April 11,
2023
Received:
January 3,
2023
Publication stage
In Press Corrected ProofFootnotes
☆All authors meet the ICMJE authorship criteria.
Identification
Copyright
© 2023 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
