Hapshy V, Imburgio S, Sanekommu H, Nightingale B, Taj S, Hossain MA, Patel S. Pylephlebitis-induced acute liver failure: A case report and review of literature. World J Hepatol 2024; 16(1): 103-108 [PMID: 38313245 DOI: 10.4254/wjh.v16.i1.103]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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 Processing time: 151 Days and 8.2 Hours
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.
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.
