Unhappy Triad: Infection with <b><i>Leptospira</i></b> spp. <b><i>Escherichia coli</i></b> and <b><i>Bacteroides uniformis</i></b> Associated with an Unusual Manifestation of Portal Vein Thrombosis

Abstract

Portal vein thrombosis (PVT) is a rare disease with an incidence of 0.7/100,000 inhabitants per year. Septic PVT (pylephlebitis) usually occurs secondary to infection in the anatomic region drained by the portal venous system. We report on a 76-year-old German male who was admitted with a history of recurrent fever and acute renal failure. Blood cultures taken on admission showed &lt;i&gt;Escherichia coli&lt;/i&gt;, as well as &lt;i&gt;Bacteroides uniformis&lt;/i&gt; after an extended incubation period of 90 h. In addition, infection with &lt;i&gt;Leptospira&lt;/i&gt; spp. was diagnosed serologically. Computerized tomography of the abdomen revealed an extensive PVT along with signs of colonic diverticulitis. Symptoms resolved under prolonged antimicrobial therapy with beta-lactams and adequate heparinization. A myeloproliferative disorder could be excluded. There was no evidence of an underlying coagulation disorder. Imaging controls showed an almost complete resolution of the PVT after 6 months of anticoagulation therapy. To the best of our knowledge, this is the first report of such an “unhappy triad,” which includes atypical manifestations of leptospirosis and involvement of other intestinal bacteria.

Suppurative Thrombosis of the Portal Vein (Pylephlebits): A Systematic Review of Literature

“…In another case, even though a troublesome focus of brain abscess was diagnosed, the patient had an indolent clinical course and successfully recovered without any complications [ 7 ]. Uncommon complications include hemorrhagic shock (due to GIT bleeding), peritonitis, multi-organ failure, biloma, empyema, and intra-abdominal sepsis [ 24 , 31 , 37 , 57 , 69 , 80 ]. Thrombosis can persist, resolve (entirely or partially), or result in a cavernous transformation of the portal vein (i.e., the formation of veins within or around the previously thrombosed PV) [ 64 , 85 ].…”