関節リウマチに対する治療経過中に発症した肝類洞閉塞症候群の1例

A female patient in her 60s who was diagnosed with rheumatoid arthritis has been treated with methotrexate for 12 years, and iguratimod for 7 years. She was referred to our department because of the liver injury and ascites. In laboratory data, PT-INR was 1.26（ 63.2%）, serum albumin was 1.9g/dL, M2BPGi was 4.97COI, indicating liver fibrosis and decreased hepatic synthesis ability. An abdominal ultrasonography（AUS） showed ascites, and liver stiffness value was 12.7 kPa using shear wave elastography, indicating F4 fibrosis in new Inuyama classification. Histopathological examination of liver biopsy showed A2 chronic active hepatitis and F2 - 3 fibrosis. In Azan staining, it showed luminal stenosis of central vein. Therefore, she was diagnosed with hepatic sinusoidal obstruction syndrome. We discontinued the administration of methotrexate and iguratimod, and then liver function was gradually improved. Hepatic sinusoidal obstruction syndrome is often associated with hematopoietic stem cell transplantation, chemotherapy drugs such as oxaliplatin, and radiation therapy. In our knowledge, this is the first report of the case with hepatic sinusoidal obstruction syndrome, which occurred during the course of rheumatoid arthritis treatment.