Related Experiment Video
Updated: Jan 9, 2026
Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
Published on: June 18, 2020
[Inotuzumab ozogamicin-associated sinusoidal obstruction syndrome/veno-occlusive disease diagnosed by transjugular
Shunichiro Yasuda1, Momoko Chiba1, Tsugumi Kaga2
1Department of Hematology, Tokyo Kyosai Hospital.
A 75-year-old man diagnosed with Philadelphia chromosome-negative B-cell acute lymphoblastic leukemia did not respond to standard induction chemotherapy, but was successfully treated with inotuzumab ozogamicin (InO). Although ascites developed after three cycles of InO, the clinical criteria for sinusoidal obstruction syndrome (SOS)/veno-occlusive disease (VOD) were not met due to the absence of jaundice and hepatomegaly. However, an increase in the HokUS-6 score from 1 to 4 led us to discontinue InO, considering the risk of SOS/VOD. Three months later, the ascites recurred and a transjugular liver biopsy (TJLB) was performed, resulting in a pathological diagnosis of SOS/VOD. Although the symptoms associated with SOS/VOD temporarily improved with recombinant thrombomodulin and other supportive care, the ascites returned 1 month later along with jaundice. The patient died of liver failure progression that showed no improvement with defibrotide. Pathological examination at autopsy revealed enlarged endothelial cells and fibrosis of the central hepatic vein. In cases where the diagnosis of SOS/VOD is inconclusive based on clinical findings and HokUS scores, TJLB may facilitate earlier diagnosis and effective therapeutic decision-making for SOS/VOD.
A 75-year-old man diagnosed with Philadelphia chromosome-negative B-cell acute lymphoblastic leukemia did not respond to standard induction chemotherapy, but was successfully treated with inotuzumab ozogamicin (InO). Although ascites developed after three cycles of InO, the clinical criteria for sinusoidal obstruction syndrome (SOS)/veno-occlusive disease (VOD) were not met due to the absence of jaundice and hepatomegaly. However, an increase in the HokUS-6 score from 1 to 4 led us to discontinue InO, considering the risk of SOS/VOD. Three months later, the ascites recurred and a transjugular liver biopsy (TJLB) was performed, resulting in a pathological diagnosis of SOS/VOD. Although the symptoms associated with SOS/VOD temporarily improved with recombinant thrombomodulin and other supportive care, the ascites returned 1 month later along with jaundice. The patient died of liver failure progression that showed no improvement with defibrotide. Pathological examination at autopsy revealed enlarged endothelial cells and fibrosis of the central hepatic vein. In cases where the diagnosis of SOS/VOD is inconclusive based on clinical findings and HokUS scores, TJLB may facilitate earlier diagnosis and effective therapeutic decision-making for SOS/VOD.
Related Concept Videos
01:26Diseases of the Liver and Gallbladder
Cirrhosis is characterized by the scarring of hepatic lobules in the liver, which are replaced by fibrous tissue, affecting the liver's normal functioning. NAFLD, on the other hand, is caused by an excessive build-up of fat in the liver, not...
01:21Hepatic Portal System
At its core, the hepatic portal vein is the result of a confluence of the superior and inferior mesenteric veins along with the splenic vein. Each of these veins has a unique role. The superior mesenteric vein is...
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...