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Published on: November 27, 2019
Pylephlebitis-induced acute liver failure: A case report and review of literature
Vera Hapshy1, Steven Imburgio2, Harshavardhan Sanekommu2
1Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, United States. vera.hapshy@hmhn.org.
Background:
Pylephlebitis is an extremely rare form of septic thrombophlebitis involving the portal vein, carrying high rates of morbidity and mortality.
Case Summary:
We present a case of a 42-year-old male with no past medical history who presented with acute onset of abdominal pain and altered mental status with laboratory tests demonstrating new-onset acute liver failure. Pylephlebitis was determined to be the underlying etiology due to subsequent workup revealing polymicrobial gram-negative anaerobic bacteremia and complete thrombosis of the main and left portal veins. To our knowledge, this is the first documented case of acute liver failure as a potential life-threatening complication of pylephlebitis.
Conclusion:
Our case highlights the importance of considering pylephlebitis in the broad differential for abdominal pain, especially if there are co-existing risk factors for hypercoagulability. We also demonstrate that fulminant hepatic failure in these patients can potentially be reversible with the immediate initiation of antibiotics and anticoagulation.
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