Sonographic diagnosis of venocclusive disease of the liver and danazol therapy for autoimmune thrombocytopenia in an autologous marrow transplant patient

Jpn J Clin Oncol. 1990 Jun;20(2):188-92.

Abstract

A 16-Year-old boy with lymphoblastic lymphoma underwent an autologous bone marrow transplantation (ABMT) after conditioning with high-dose busulfan and cyclophosphamide. On day 39 post-transplant, right upper quadrant pain occurred with an increase in the size of the liver. Liver function tests showed a subsequent deterioration. Ultrasonographic studies of the abdomen disclosed hepatosplenomegaly, ascites, thickening of the gall bladder wall and a failure to visualize the major hepatic veins. The venocclusive disease of the liver (VOD) diagnosis was confirmed from these findings. Ultrasonographic monitoring reflected the disease status well and demonstrated a complete recovery from the VOD. We emphasize, thus, that abdominal ultrasonography can be applied easily, being a non-invasive procedure, and is useful in diagnosing VOD. Furthermore, the procedure can be repeated serially for evaluating the severity of VOD. Although engraftment was confirmed with granulocytes exceeding 500/microliters, platelet recovery was delayed; the megakaryocytes had not decreased in bone marrow aspirates and platelet-associated IgG was significantly elevated. Since autoimmune thrombocytopenia was highly suspected, to prevent immunosuppression danazol was given as an immune modulator instead of prednisolone, and a complete recovery was obtained. Accordingly, danazol can be used as an alternative to prednisolone for the treatment of autoimmune thrombocytopenia after bone marrow transplantation.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Autoimmune Diseases / complications
  • Autoimmune Diseases / drug therapy*
  • Bone Marrow Transplantation / adverse effects*
  • Danazol / therapeutic use*
  • Hepatic Veno-Occlusive Disease / complications
  • Hepatic Veno-Occlusive Disease / diagnosis*
  • Humans
  • Lymphoma, Non-Hodgkin / blood
  • Lymphoma, Non-Hodgkin / surgery*
  • Male
  • Pregnadienes / therapeutic use*
  • Thrombocytopenia / complications
  • Thrombocytopenia / drug therapy*
  • Ultrasonography*

Substances

  • Pregnadienes
  • Danazol