Complex postpartum fever caused by ovarian vein thrombophlebitis combined with acute pyelonephritis: a rare case...

Ovarian vein thrombophlebitis (OVT) is a rare but serious postpartum complication. This report presents a case of OVT with acute pyelonephritis successfully managed at our hospital. By summarizing the clinical course, diagnostic process, and treatment-alongside a literature review-it aims to improve clinical recognition and management of this uncommon condition.

A 28-year-old woman in the early postpartum period was admitted to the Department of Obstetrics and Gynecology with persistent high fever and flank pain. Diagnostic evaluations included contrast-enhanced abdominal computed tomography (CT), urinary tract ultrasonography, and routine blood and urine tests. A multidisciplinary team formulated an individualized treatment plan consisting of right-sided ureteral double-J stent placement, antimicrobial therapy with meropenem, anticoagulation with low-molecular-weight heparin, and supportive care including fluid resuscitation. Based on clinical symptoms, physical examination, and imaging findings, a diagnosis of ovarian vein thrombophlebitis (OVT) complicated by acute pyelonephritis was established. The patient responded well to the comprehensive treatment regimen, with significant reductions in inflammatory markers-white blood cell count (WBC), neutrophil percentage (NEUT), C-reactive protein (CRP), and procalcitonin (PCT). Coagulation function normalized, and both fever and flank pain were notably alleviated. She achieved full recovery after 15 days of hospitalization and showed no abnormalities at the 42-day postpartum follow-up.

OVT complicated with acute pyelonephritis often manifests as persistent postpartum fever and flank pain, with poor response to first- and second-line antibiotics. Diagnosis relies on contrast-enhanced abdominal CT and urinary tract ultrasound, supplemented by coagulation studies. Early ureteral double-J stent placement, combined with third-line antibiotic therapy and anticoagulation, is essential for effective infection control and prevention of thrombus progression. In postpartum patients with unexplained fever and flank pain, clinicians should maintain a high index of suspicion for OVT and complicated urinary tract infections.