Two and Half Years Later: Cytomegalovirus and Ebstein Barr Virus Infection Leading to Sinusoidal Obstruction Syndrome in Liver Transplant Recipient

Submitted by sysadmin1 on Tue, 08/29/2017 - 10:35
Oncology, Gastroenterology and Hepatology Reports,2018,7,1,35-37.
Published:September 2017
Type:Case Report

Two and Half Years Later: Cytomegalovirus and Ebstein Barr Virus Infection Leading to Sinusoidal Obstruction Syndrome in Liver Transplant Recipient

Cyriac Abby Philips1*, Philip Augustine2, Pushpa Mahadevan3

1Department of Hepatology and Transplant Medicine, PVS Memorial Hospital, Kochi, Kerala, INDIA.

2Department of Gastroenterology, PVS Memorial Hospital, Kochi, Kerala, INDIA.

3Department of Pathology, VPS Lakeshore Hospital, Kochi, Kerala, INDIA.

Abstract:

Veno-occlusive disease or sinusoidal obstruction syndrome (SOS) occurring after LT is quite rare often taking a life-threatening course. The causes of SOS in a liver transplant recipient have been found to be associated with certain factors such as azathioprine use, acute rejection and tacrolimus, mostly presenting in the immediate post op period or within 3 months. However SOS occurring in a liver transplant recipient beyond 2 years has not been documented. We report a stable post-transplant recipient with dual viral (CMV and EBV) insults 2 and half years later leading to steroid and anti thymocyte globulin resistant late acute severe rejection with rapidly progressive SOS.

Contrast enhanced computed tomography of the abdomen revealing normal liver graft parenchyma and vasculature without biliary tract disease (A); extensive mesenterico-omental inflammation and loss of fat tissue (B) with severe enterocolitis (C).

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