Portal Vein Thrombosis and Pyogenic Liver Abscess With Concomitant Bacteroides Bacteremia in a Patient With COVID-19 Infection: A Case Report and Brief Review

Abstract

The 2019 coronavirus disease (COVID-19) can present with a wide variety of clinical manifestations, including a hypercoagulable state leading to both arterial and venous thrombosis. Portal vein thrombosis (PVT) in the setting of COVID-19 has rarely been reported in the medical literature. Pylephlebitis with concomitant liver abscess is a rare complication of intra-abdominal infection. Here, we present the case of a 49-year-old man who initially presented with intermittent fevers and generalized weakness of 1-month duration and was subsequently found to have COVID-19 infection, PVT, and Bacteroides fragilis bacteremia with associated pyogenic liver abscess. The patient was treated with intravenous antibiotics and oral anticoagulation with plan to follow up outpatient with gastroenterology in 3 months to ensure resolution of PVT and liver abscess.

Septic Pylephlebitis in the Setting of COVID-19 Infection: A Case Report

“…Pylephlebitis is a rare complication of intra-abdominal infections that causes a suppurative infection of the porto-mesenteric venous thrombus with a mortality rate greater than 20% [ 1 ]. It is associated with appendicitis, diverticulitis, IBD, cholecystitis, pancreatitis, or recent abdominal surgeries.…”

“…An intra-abdominal infection with potential extension into the portal venous system in a concurrent hypercoagulable state provides a nidus for enteric commensals to form septic thrombophlebitis. Positive blood culture is often seen in more than half of the cases, with the most common single isolates being Bacteroid species, E. coli , and Streptococcus species [ 1 , 3 ]. In our case, the recurrence of Streptococcus mitis bacteremia is likely due to the presence of PVT from COVID-19, which acted as a nidus for infection.…”

“…Findings indicative of septic thrombophlebitis include portal vein dilatation proximal to occlusion with wall thickening, portal venous gas, the presence of collateral vessels, and complications of hepatic abscess or intestinal ischemia [ 7 , 8 ]. FDG-PET and hepatic Tc-99 scintigraphy can be used as adjuncts for diagnostic confirmation in limited cases [ 1 ].…”

“…Portal vein thrombophlebitis, a narrowing or blockage of the portal vein by a blood clot, is a complication of intra-abdominal or pelvic infection that usually starts with thrombophlebitis of the small veins that drain the site of infection and extends to larger veins, leading to thrombophlebitis of the portal vein [ 1 ]. A combination of thrombophlebitis of the portal venous system (PVS) and superimposed bacterial infection can develop, labeled septic pylephlebitis, which is usually seen as a complication of diverticulitis and appendicitis [ 2 ].…”

COVID‐19 infection may present as acute abdomen

“…A review on contemporary literature for patients with COVID‐19–induced portal vein thrombosis is summarised in Tables 2–4 3–14 . COVID‐19–induced portal vein thrombosis tended to have a male predominance with an age range from 26 to 82, with a median age of 50 years.…”