Scientific Letters
Vol. 17 No. 1 (2025): Review Articles, Original Article, Scientific Letter, Case Reports Letter to the Editor
https://doi.org/10.4084/MJHID.2025.068

Late-Onset Veno-Occlusive Disease (VOD) Post-Haploidentical Transplant: A Diagnostic Challenge Requiring Liver Biopsy– A Case Report

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Received: June 27, 2025
Accepted: July 19, 2025
Published: August 31, 2025
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Haploidentical HSCT, sinusoidal obstruction syndrome

Authors

Mehak Trehan
All India Institute of Medical sciences, Delhi, India.
Homdutt Sharma
a:1:{s:5:"en_US";s:46:"All India Institute of Medical sciences, Delhi";}, India.
Abhinav Sengupta
All India Institute of Medical sciences, Delhi, India.
Anirudh Burli
All India Institute of Medical sciences, Delhi, India.
Pradeep Kumar
doctorpkgmu@gmail.com
All India Institute of Medical sciences, Delhi, India.
Manoranjan Mahapatra
All India Institute of Medical sciences, Delhi, India.

Abstract

Background: Veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is a potentially fatal complication post-hematopoietic stem cell transplantation (HSCT), classically presenting within the first 3 weeks. However, late-onset VOD, often presenting beyond day +21, may lack the classical hallmarks, making diagnosis particularly challenging.

Case Presentation: We report a 41-year-old female with adverse-risk acute myeloid leukemia (AML) who underwent haploidentical HSCT in first complete remission. On day +35, she developed hemorrhagic cystitis due to BK polyomavirus and CMV viremia, followed by progressive abdominal distension, hepatomegaly, ascites, and mild hyperbilirubinemia. Initial imaging and laboratory investigations were non-specific. A diagnostic transjugular liver biopsy performed on day +52 revealed classical features of SOS with zone 3 perisinusoidal fibrosis. She was managed conservatively with complete clinical resolution.

Conclusion: This case highlights the diagnostic complexity of late-onset VOD and reinforces the indispensable role of liver biopsy when conventional criteria are inconclusive.

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Citations

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How to Cite



“Late-Onset Veno-Occlusive Disease (VOD) Post-Haploidentical Transplant: A Diagnostic Challenge Requiring Liver Biopsy– A Case Report” (2025) Mediterranean Journal of Hematology and Infectious Diseases, 17(1), p. e2025068. doi:10.4084/MJHID.2025.068.
Copyright (c) 2025 Mehak Trehan, Homdutt Sharma, Abhinav Sengupta, Anirudh Burli, Pradeep Kumar, Manoranjan Mahapatra Creative Commons License

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