Endotipsitis: an emerging prosthetic-related infection in patients with portal hypertension

The transjugular intrahepatic portosystemic shunt (TIPS) is an option for the treatment of portal hypertension. However, TIPS infection (endotipsitis) is distinctly uncommon. We report 3 new patients and review 23 published cases of endotipsitis. We calculate an incidence of 1.33% in patients undergoing the procedure. Twenty-three cases (88%) occurred more than a month after the procedure. The most common presentation included fever and primary bacteremia or fungemia. Gram-positive (18 cases), gram-negative microorganisms (10 cases), and fungi (3 cases) were the etiologic agents. Diagnosis may be difficult to establish, and new diagnostic criteria have been proposed. Twenty patients responded well to antibiotic treatment, and the 6 remaining patients died because of the infection. Endotipsitis is a new infectious disease to be considered in patients with a TIPS and bloodstream infection that is not clearly attributable to another source. Prolonged courses of antimicrobial agents can be curative, but liver transplantation is also an option to consider.