Two and Half Years Later: Cytomegalovirus and Ebstein Barr Virus Infection Leading to Sinusoidal Obstruction Syndrome in Liver Transplant Recipient

Veno-occlusive disease or sinusoidal obstruction syndrome (SOS) occurring after LT is quite rare often taking a life-threatening course. The causes of SOS in a liver transplant recipient have been found to be associated with certain factors such as azathioprine use, acute rejection and tacrolimus, mostly presenting in the immediate post op period or within 3 months. However SOS occurring in a liver transplant recipient beyond 2 years has not been documented. We report a stable post-transplant recipient with dual viral (CMV and EBV) insults 2 and half years later leading to steroid and anti thymocyte globulin resistant late acute severe rejection with rapidly progressive SOS.