Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 27, 2024; 16(1): 103-108
Published online Jan 27, 2024. doi: 10.4254/wjh.v16.i1.103
Pylephlebitis-induced acute liver failure: A case report and review of literature
Vera Hapshy, Steven Imburgio, Harshavardhan Sanekommu, Brandon Nightingale, Sobaan Taj, Mohammad A Hossain, Swapnil Patel
Vera Hapshy, Steven Imburgio, Harshavardhan Sanekommu, Brandon Nightingale, Sobaan Taj, Mohammad A Hossain, Swapnil Patel, Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, United States
Author contributions: Hapshy V wrote and edited the manuscript in addition to contributing to the literature review; Imburgio S wrote and edited the manuscript in addition to contributing to the literature review; Sanekommu H wrote and edited the manuscript; Nightingale B wrote and edited the manuscript; Hossain MA and Taj S edited and supervised the manuscript; Patel S edited and supervised the manuscript.
Informed consent statement: Patient provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vera Hapshy, DO, Doctor, Department of Internal Medicine, Jersey Shore University Medical Center, 1945 NJ-33, Neptune, NJ 07753, United States. vera.hapshy@hmhn.org
Received: August 25, 2023
Peer-review started: August 25, 2023
First decision: September 14, 2023
Revised: October 24, 2023
Accepted: December 12, 2023
Article in press: December 12, 2023
Published online: January 27, 2024
Abstract
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.

Keywords: Portal vein thrombosis, Septic thrombophlebitis, Gram negative anaerobic bacteremia, Pylephlebitis, Acute liver failure, Case report

Core Tip: Septic thrombosis of the portal vein, also known as pylephlebitis, is difficult to diagnose as it often presents with non-specific symptoms including fever and abdominal pain. As a result, a high clinical suspicion for pylephlebitis is warranted since this condition is life-threatening without treatment. We aim to highlight acute liver failure as a possible life-threatening sequela of pylephlebitis. Furthermore, we demonstrate that prompt initiation of antibiotics and possible anticoagulation can result in complete resolution of fulminant hepatic failure.