Oxaliplatin-induced porto-sinusoidal vascular disease manifesting as recurrent gastroesophageal variceal hemorrhage: a case report

Porto-sinusoidal vascular disease (PSVD) is an increasingly recognized cause of non-cirrhotic portal hypertension, characterized by structural abnormalities of the portal microvasculature and hepatic sinusoids in the absence of cirrhosis. Recognized predisposing factors include immune-mediated conditions, infections and exposure to hepatic sinusoid-toxic agents, among others. We report a 44-year-old woman with a history of oxaliplatin-based chemotherapy for colon cancer who presented with recurrent hematochezia, hematemesis, and transient encephalopathy. Evaluation demonstrated portal hypertension and portal vein thrombosis; however, liver biopsy showed no cirrhosis and the hepatic venous pressure gradient (HVPG) was within normal limits. Her medication history, combined with these findings, confirmed the diagnosis of oxaliplatin-induced PSVD. This case highlights the importance of considering PSVD in patients with non-cirrhotic portal hypertension, particularly when there is a history of exposure to agents toxic to the hepatic sinusoids, such as oxaliplatin.