Hepatic sinusoidal obstruction syndrome following hematopoietic stem cell transplantation.

J.m., a 43-year-old man with acute myelogenous leukemia with a monosomy 7 cytogenetic abnormality, received an allogeneic hematopoietic stem cell transplantation (HscT) from his human leukocyte antigen– matched brother. Past treatments included idarubicin and cytarabine induction therapy followed by a cycle of high-dose cytarabine. J.m. was in complete remission prior to the HscT. The conditioning regimen for the HscT was busulfan and cyclophosphamide. Eighteen days after his HscT, J.m.’s total bilirubin had risen from 1.0 mg/dl the previous day to 3.6 mg/dl. His alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase were normal. J.m. complained of mild right upper-quadrant abdominal pain (3 on a 0–10 scale). J.m. had been gaining one to two pounds per day over the past few days, for a total of 10 pounds in the past week. He was slightly jaundiced. The transplantation team suspected that J.m. was developing hepatic sinusoidal obstruction syndrome (sOs).