Veno-Occlusive Disease of the Liver After Chemotherapy of Acute Leukemia

Abstract

Two adult male patients with acute leukemia developed a fatal Budd-Chiari-like illness while receiving 6-thioguanine. Both previously received cytosine arabinoside. Antemortem and postmortem specimens of liver showed changes characteristic of toxic venoocclusive disease. Similar findings were described after ingestion of certain plant alkaloids and after treatment with arsphenamine, urethane and ionizing radiation to the liver. Venoocclusive disease of the liver after treatment with 6-thioguanine or cytosine arabinoside was not previously reported. Although 6-thioguanine was most likely responsible for this syndrome, it is not possible to eliminate cytosine arabinoside as the causative agent. Since both drugs are occasionally used for benign conditions, physicians should be aware of this possible complication.