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Case Reports
. 2021 Jul 6;15(2):598-602.
doi: 10.1159/000517094. eCollection 2021 May-Aug.

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

Sven Kalbitz  1 , Jörg Ermisch  1 , Jonathan M Schmidt  1   2 , Ingo Wallstabe  2 , Christoph Lübbert  1   3   4
Affiliations
Case Reports

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

Sven Kalbitz et al. Case Rep Gastroenterol. .

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 Escherichia coli, as well as Bacteroides uniformis after an extended incubation period of 90 h. In addition, infection with Leptospira 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.

Keywords: Anticoagulation; Case report; Colonic diverticulitis; Leptospirosis; Polymicrobial infection; Pylephlebitis; Septic portal vein thrombosis.

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Conflict of interest statement

The authors report no competing interests.

Figures

Fig. 1
Fig. 1
Contrast-enhanced CT (coronal reconstruction) of the abdomen: arrows point toward the PVT (black arrow: main branch of the portal vein filled with contrast medium; white arrow: portal vein thrombus). PVT, portal vein thrombosis; CT, Computerized tomography.
Fig. 2
Fig. 2
Ultrasound image (B mode) of the PVT (extent of the thrombus: 36.5 × 35.4 mm). PVT, portal vein thrombosis.
Fig. 3
Fig. 3
Duplex ultrasound image of the liver at 6-month follow-up, showing almost complete resolution of the PVT in the main branch with arterialization of the left liver lobe. PVT, portal vein thrombosis.
See this image and copyright information in PMC

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