Sinusoidal obstruction syndrome associated with disseminated toxoplasmosis involving the liver after allogeneic hematopoietic stem cell transplantation: A case report.

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.

Informations de copyright

Copyright © 2023 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest T.T. reports lecture fees and consulting fees from Sanofi, France, and research funding from Pfizer, United States. M.N. reports lecture fees from Otsuka Pharmaceutical, Japan, and research funding from Pfizer, United States and Astellas, Japan. Y.N. reports research funding from Astellas, Japan. M.N. reports payment (lecture fees) to spouse (Please refer to H.N. disclosure). M.H. reports grants from Otsuka Pharmaceutical, Japan, and Astellas, Japan, and lecture fees from Otsuka Pharmaceutical, Japan, Sanofi, France, Pfizer, United States, and Astellas, Japan. H.N. reports lecture fees from Otsuka Pharmaceutical, Japan, and Astellas, Japan. The other authors declare no conflicts of interest associated with this manuscript.