Pylephlebitis caused by a liver abscess

Abstract

Pylephlebitis is a rare complication associated with an intra-abdominal septic process in the portal venous system. It is defined as thrombophlebitis of the portal vein and is often reported in association with appendicitis and diverticulitis. We present a 64-yearold female who presented with fever, chills, myalgia, and loss of appetite. A computerized tomography (CT) chest/abdomen/pelvis was performed and the patient was found to have a low-density lesion within the left lobe of the liver suspicious for a hepatic abscess and a suspected left segmental plyephlebitis. The diagnosis of pylephlebitis can be challenging as there is a broad differential diagnosis to consider. When considering pylephlebitis, empiric antibiotic coverage for poly-microbial infection targeting both gram-negative aerobes and anaerobes should be initiated. Antimicrobial therapy is modified according to blood culture results and treatment can be extended for 4 to 6 weeks. To our knowledge, there are only a few cases identifying liver abscesses as an etiology for pylephlebitis. This case was atypical compared to other cases in that the diagnosis of pylephlebitis
was incidental.