A rare case of Hepatic Sinusoidal obstruction syndrome due to a drug use

A rare case of Hepatic Sinusoidal obstruction syndrome due to a drug use

Melike Ruşen Metin1,  Hasan Aydın2

1Specialist, TC.SB. Ankara Bilkent City hospital Radiology Department, ANKARA-TURKEY Tlf: 0090-312-5526000.
2Associate Professor, University of Health Sciences, TC.SB. Ankara Oncology Research hospital Radiology Department, ANKARA-TURKEY.

International-Journal-of-Case-Reports-2d code

Here, we report a case of hepatic sinusoidal obstruction syndrome(HSOS) of a 30 years old female patient with Ulcerative colitis(UC) who was being treated by mesalazine.
The patient was admitted to the emergency unit by harsh and cramping abdominal pain, she had increased AST-ALT-Bilirubine and GGT levels in the blood laboratory analysis. In the Portal venous Doppler US; Splenomegaly and coarse granular appearance in liver parenchymal echogenecity were observed. In the abdominal CT, Splenomegaly was confirmed.
In the Dynamic Abdominal MRI, pathognomonic liver finding which was the patchy contrast-enhancing reticular appearance, was visualized and the exact diagnosis was handled by true-cut biopsy.
The aid of Dynamic Abdominal MRI to the early diagnosis of HSOS was also demonstrated in this case.

Keywords: Hepatic; Veno-occlusive; Diseases; MRI; Mesalazine

Free Full-text PDF

How to cite this article:

Melike Ruşen Metin, Hasan Aydın. A rare case of Hepatic Sinusoidal obstruction syndrome due to a drug use. International Journal of Case Reports, 2020; 4:164. DOI: 10.28933/ijcr-2020-08-2906


1. De Leve LD, Shulman HM, McDonald GB. Toxic injury to hepatic sinusoids: sinusoidal obstruction syndrome (veno-occlusive disease). Semin Liver Dis 2002; 22(1):27–42
2. Kumar S, DeLeve LD, Kamath PS, Tefferi A. Hepatic veno-occlusive disease (sinusoidal obstruction syndrome) after hematopoietic stem cell transplantation. Mayo Clin Proc 2003;78:589-98
3. Alpert LI. Veno-occlusive disease of the liver associated with oral contraceptives: case report and review of literature. Hum Pathol 1976;7:709-18.
4. Fajardo LF, Colby TV. Pathogenesis of veno-occlusive liver disease after radiation. Arch Pathol Lab Med 1980;104:584-8.
5. Meresse V, Hartmann O, Vassal G, Benhamou E, Valteau-Couanet D, Brugieres L, et al. Risk factors for hepatic veno-occlusive disease after high-dose busulfan containing regimens followed by autologous bone marrow transplantation: a study in 136 children. Bone Marrow Transplant 1992;10:135-41.
6. Ayash LJ, Hunt M, Antman K, Nadler L, Wheeler C, Takvorian T, et al. Hepatic veno-occlusive disease in autologous bone marrow transplantation of solid tumors and lymphomas. J Clin Oncol 1990;8:1699-1706.
7. Philip J. Robinson A.The effects of cancer chemotherapy on liver imaging. Eur Radiol 2009 19: 1752–62.
8. Zhoue H, Yi-Xiang J. Wang M, Lou HY, Xu XJ, Zhang M. Hepatic Sinusoidal Obstruction Syndrome Caused by Herbal Medicine: CT and MRI Features. Korean J Radiol 2014;15(2):218-25.
9. Erturk SM, Mortele KJ, Binkert CA, Glickman JN, Oliva MR, Ros PR, et al. CT features of hepatic veno-occlusive disease and hepatic graft-versus-host disease in patients after hematopoietic stem cell transplantation. AJR 2006;186:1497-1501.
10. Van den Bosch MA, Van Hoe L. MR imaging findings in two patients with hepatic veno-occlusive disease following bone marrow transplantation. Eur Radiol 2000;10:1290-3.
11. Brancatelli G, Furlan A, Calandra A, Dioguardi Burgio M. Hepatic sinusoidal dilatation. Abdom Radiol (NY). 2018;43(8):2011-22. doi: 10.1007/s00261-018-1465-8.
12. Holtmann M, Schreiner O, Köhler H, Denzer U, Neurath M, Galle PR, et al. Veno-occlusive disease in Crohn’s disease treated with azathioprine. Dig Dis Sci. 2003;48(8):1503-5.
13. Russmann S, Zimmermann A, Krähenbühl S, Kern B, Reichen J. Veno-occlusive disease, nodular regenerative hyperplasia and hepatocellular carcinoma after azathioprine treatment in a patient with ulcerative colitis. Eur J Gastroenterol Hepatol. 2001;13(3):287-90.