Lemierre's syndrome variant of the gut

Abstract

Infectious suppurative thrombophlebitis of the portal venous system, referred to as pylephlebitis, is a rare complication of intra-abdominal inflammatory processes. Advances in diagnostics and antibiotics have improved survival, but mortality remains remarkably high even in the most recent literature. The majority of patients have concomitant bacteraemia on presentation most commonly with typical gastrointestinal (GI) organisms. On rare occasion, patients have culture positive Fusobacterium, which has recently been associated with occult GI and genitourinary malignancies. Here, we describe a patient presenting with pylephlebitis and Fusobacterium bacteraemia who responded well to medical therapy, review pertinent literature and discuss the benefits of screening endoscopy in this patient population.

Keywords: haematology (incl blood transfusion); infection (gastroenterology); infectious diseases.

Figure 1

CT abdomen/pelvis demonstrating multiple descending and sigmoid colonic diverticula with a 2.5×2.7×2.3 cm sigmoid diverticular phlegmon denoted by yellow oval and inferior mesenteric vein thrombosis demarcated by red arrow, which extends proximally to its confluence with the superior mesenteric vein and main portal vein (not visualised on the image).

Figure 2

Four-week interval follow-up CT abdomen/pelvis showing significant improvement in sigmoid abscess denoted by yellow circle and complete resolution of inferior mesenteric vein thrombosis.