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Fusobacterium necrophorum subsp. necrophorum Liver Abscess with Pylephlebitis: An Abdominal Variant of Lemierre's

Natasa Radovanovic1, Igor Dumic2,3, Mladjen Veselinovic4

  • 1Internal Medicine Residency Program, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.

Case Reports in Infectious Diseases
|January 30, 2020
PubMed

Insights

Rarely reported liver abscess with suppurative portal vein thrombosis (pylephlebitis) due to Fusobacterium necrophorum can be fatal. This case highlights the importance of recognizing this Lemierre's syndrome variant for prompt diagnosis and treatment.

Area of Science:

  • Gastroenterology and Hepatology
  • Infectious Diseases
  • Vascular Surgery

Background:

  • Suppurative portal vein thrombosis (pylephlebitis) is a rare but serious complication, often secondary to intra-abdominal infections.
  • Fusobacterium necrophorum is an uncommon pathogen implicated in severe infections, including Lemierre's syndrome.
  • Liver abscess co-occurring with pylephlebitis presents a diagnostic and therapeutic challenge.

Observation:

  • A 69-year-old male presented with liver abscess and pylephlebitis.
  • The infection was attributed to Fusobacterium necrophorum, with an unclear primary source.
  • The patient's clinical presentation and outcome were analyzed in the context of existing literature.

Findings:

  • This case represents a rare instance of liver abscess and pylephlebitis caused by F. necrophorum.
  • The condition is considered an abdominal manifestation of Lemierre's syndrome, associated with high morbidity and mortality.
  • Diagnosis and management require a high index of suspicion and prompt intervention.

Implications:

  • Early recognition and aggressive management are crucial for improving outcomes in patients with F. necrophorum-associated pylephlebitis.
  • Understanding the pathogenesis of this rare syndrome can guide diagnostic and treatment strategies.
  • Further research into F. necrophorum infections may elucidate optimal therapeutic approaches for similar cases.

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