Hepatic Vein Pylephlebitis as a Cause of Bilateral Pyopneumothorax

Pylephlebitis is a rare complication of intra-abdominal infections and has a significant mortality rate, necessitating early recognition for optimal treatment. Here, we present the case of a 36-year-old male with fever, shortness of breath, cough, and epigastric pain. He was ultimately diagnosed with hepatic vein pylephlebitis along with multiple pulmonary and hepatic lesions believed to be septic emboli and hepatic abscess. He developed recurrent bilateral pyopneumothorax which required drainage by interventional radiology multiple times. The patient improved and was discharged on intravenous antibiotics for four weeks. While hepatic abscesses are a known complication of pylephlebitis, pyopneumothorax is a rare, unreported complication. Recognition of this potential complication is important for clinicians when treating patients with hepatic vein pylephlebitis.