<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2341-4545</journal-id>
<journal-title><![CDATA[GE-Portuguese Journal of Gastroenterology]]></journal-title>
<abbrev-journal-title><![CDATA[GE Port J Gastroenterol]]></abbrev-journal-title>
<issn>2341-4545</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Gastrenterologia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2341-45452024000600061</article-id>
<article-id pub-id-type="doi">10.1159/000536535</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Transjugular Liver Biopsy: The Key to a Rare Etiology of Cholestatic Hepatitis after Bone Marrow Transplantation]]></article-title>
<article-title xml:lang="pt"><![CDATA[Biópsia hepática transjugular: a chave para uma rara etiologia de hepatite colestática após transplante de progenitores hematopoiéticos]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pestana]]></surname>
<given-names><![CDATA[Inês]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pedro]]></surname>
<given-names><![CDATA[Juliana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Simões]]></surname>
<given-names><![CDATA[Carolina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ferreira]]></surname>
<given-names><![CDATA[Carlos Noronha]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mata]]></surname>
<given-names><![CDATA[Sara da]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Claro]]></surname>
<given-names><![CDATA[Isabel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Amato Lusitano ULSCB Serviço de Gastrenterologia ]]></institution>
<addr-line><![CDATA[Castelo Branco ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Centro Hospitalar Universitário Lisboa Norte Serviço de Gastrenterologia e Hepatologia ]]></institution>
<addr-line><![CDATA[Lisboa ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Instituto Português de Oncologia de Lisboa Francisco Gentil Serviço de Gastrenterologia ]]></institution>
<addr-line><![CDATA[Lisboa ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Universidade de Lisboa Faculdade de Medicina de Lisboa Clínica Universitária de Gastrenterologia]]></institution>
<addr-line><![CDATA[Lisboa ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af5">
<institution><![CDATA[,Instituto Português de Oncologia de Lisboa Francisco Gentil Serviço de Anatomia Patológica ]]></institution>
<addr-line><![CDATA[Lisboa ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2024</year>
</pub-date>
<volume>31</volume>
<numero>6</numero>
<fpage>61</fpage>
<lpage>66</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2341-45452024000600061&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2341-45452024000600061&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2341-45452024000600061&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction: Hematopoietic stem cell transplantation (HSCT) is associated with multiple complications, such as sinusoidal obstruction syndrome (SOS) (hepatomegaly, ascites, jaundice, and thrombocytopenia) and graft-versus-host disease (GVHD) (with the skin, gastrointestinal tract, and liver being the main targets). These entities may present overlapping clinical &#64257;ndings, being considered differential diagnoses, but their coexistence is rare.  Case Presentation: A 29-year-old male with acute myeloid leukemia underwent HSCT. On day (D)+20, he developed hyperbilirubinemia, pleural effusion, ascites, and painful hepatomegaly. Abdominal ultrasound was suggestive of SOS, and de&#64257;brotide was initiated. On D+44, acute cutaneous, intestinal, and hepatic GVHD developed which improved after treatment with methylprednisolone. On D+132, there was worsening cholestasis and abdominal pain. MRCP revealed strictures in several segments of the intrahepatic bile ducts and irregularity of the main bile duct. Due to aggravation of liver enzyme changes and clinical worsening, he was admitted to the Intensive Care Unit. Due to persistence of severe hyperbilirubinemia (30 mg/dL) and thrombocytopenia (30,000 cell/uL), he underwent a hepatic hemodynamic study which revealed a hepatic venous pressure gradient of 10 mm Hg. The transjugular liver biopsy revealed canalicular hepatic cholestasis, bile duct injury, and focal hepatocellular necrosis suggestive of GVHD as well as injury to centrilobular veins and centrilobular necrosis compatible with possible SOS. Mycophenolate mofetil was started, but on D+195, the patient died of septic shock.  Discussion/Conclusion: This case is notable for its complexity and for demonstrating the rare coexistence of histological features of SOS and GVHD. Although the clinical and laboratory &#64257;ndings may be suf&#64257;cient for the diagnosis, it is important to highlight the importance of liver hemodynamic study and transjugular liver biopsy in these patients who often have severe thrombocytopenia, for the characterization and histological con&#64257;rmation of cholestatic hepatitis, especially when the etiology may be multifactorial.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução:  O transplante de progenitores hematopoéticos (HSCT) está associado a múltiplas complicações, como Síndrome de Obstrução Sinusoidal hepática (SOS) (hepatomegalia, ascite, icterícia e trombocitopenia) e Doença do Enxerto contra Hospedeiro (GVHD) (pele, tracto gastrointestinal e fígado como principais alvos). Estas entidades podem apresentar quadros clínicos sobreponíveis, sendo consideradas diagnósticos diferenciais mas a coexistência é rara.  Caso Clínico:  Um homem de 29 anos com leucemia mieloide aguda foi submetido a HSCT. No dia (D)+20, apresentou hiperbilirrubinemia, derrame pleural, ascite e hepatomegalia dolorosa. Ecogra&#64257;a foi sugestiva de SOS e foi iniciado de&#64257;brotido. No D+44, desenvolveu GVHD cutânea, intestinal e hepática aguda, com melhoria após tratamento com metilprednisolona. No D+132, agravamento de colestase e dor abdominal. A CPRM revelou estenoses em vários segmentos das vias biliares intra-hepáticas e irregularidade da parede da via biliar principal. Devido ao agravamento clínico e analítico, foi internado na Unidade de Cuidados Intensivos. Por manter hiperbilirrubinemia (30 mg/dL) e trombocitopenia (30.000 células/uL), foi submetido a estudo hemodinâmico hepático que revelou gradiente de pressão venosa hepática de 10 mm Hg. A biópsia hepática transjugular revelou colestase hepática canalicular, lesão dos ductos biliares e necrose hepatocelular focal sugestivos de GVHD, assim como e lesão de veias centrolobulares e necrose centrolobular compatível com possível SOS. Iniciou micofenolato de mofetil, mas em D+195 faleceu no contexto de choque séptico.  Discussão/Conclusão:  Este caso destaca-se pela sua complexidade e por demonstrar a rara coexistência de aspectos histológicos de SOS e GVHD. Embora o quadro clínico e analítico possa ser su&#64257;ciente para o diagnóstico, é de relevar a importância da biópsia hepática transjugular em doentes imunossuprimidos com trombocitopénia grave para caracterização e con&#64257;rmação histológica de quadros de hepatite colestática, sobretudo quando a etiologia pode ser multifactorial.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Transjugular liver biopsy]]></kwd>
<kwd lng="en"><![CDATA[Liver graft-versus-host disease]]></kwd>
<kwd lng="en"><![CDATA[Hepatic sinusoidal obstruction syndrome]]></kwd>
<kwd lng="en"><![CDATA[Hematopoietic stem cell transplantation]]></kwd>
<kwd lng="pt"><![CDATA[Biópsia hepática transjugular]]></kwd>
<kwd lng="pt"><![CDATA[Doença do enxerto contra hospedeiro hepática]]></kwd>
<kwd lng="pt"><![CDATA[Síndrome de obstrução sinusoidal hepática]]></kwd>
<kwd lng="pt"><![CDATA[Transplante de progenitores hematopoiéticos]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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