Sinusoidal Obstruction Syndrome after Autologous Stem Cell Transplant

Introduction: Vaso-occlusive crisis or Sinusoidal obstruction syndrome (SOS) is a clinical entity generally observed after allogeneic stem cell transplant. Its classical form occurs typically after rescue stem cell infusion, and the risk is maximum till day +21 of the transplant. The etiopathogenesis includes the conditioning regimen that causes endothelial injury, the cytokines released from damaged tissue, and the immunosuppressive agents used to prevent graft rejection and graft-versus-host disease. It manifests as tender hepatomegaly, ascites, and deranged liver function tests. Occurrence during an autologous stem cell transplant is rare. Case- We describing a case of a 58-year-old male with multiple myeloma admitted for autologous hematopoietic stem cell transplant complicated by SOS. The patient's serum bilirubin level increased to 7.8mg/dl, accompanied by tender hepatomegaly and weight gain. Whole abdomen ultrasound examination showed hepatomegaly. The diagnosis was made using modified Seattle criteria and managed conservatively with diuretics, fluid restriction, and supportive treatment. Conclusion: Sinusoidal obstruction syndrome can occur in an autologous stem cell transplant. Restricted fluid intake and supportive therapy can be sufficient to manage SOS.