Septic Pylephlebitis in the Setting of COVID-19 Infection: A Case Report

TL;DR

A 74-year-old woman with a history of lymphoma and diabetes developed septic pylephlebitis during a severe case of COVID-19, requiring prolonged treatment and highlighting the rare but serious complications of the virus.

Contribution

This case report highlights septic pylephlebitis as a rare but severe complication of COVID-19, emphasizing the need for vigilance in managing hypercoagulable states in infected patients.

Findings

The patient developed portal vein thrombosis and septic pylephlebitis following a severe course of COVID-19.

Prolonged fever in the patient indicated extensive thrombosis at unusual sites, leading to significant morbidity.

Anticoagulation and long-term antibiotic therapy were essential in managing the patient's condition.

Abstract

Portal vein thrombophlebitis is a rare complication that can occur in various hypercoagulable states, including COVID-19. We are presenting a 74-year-old female with a history of hypertension, diabetes, and lymphoma who contracted the COVID-19 infection and presented with persistent fever, leukocytosis, and mild epigastric tenderness. She developed hypotension, acute hypoxic respiratory failure, and worsening leukocytosis with bandemia and was diagnosed with portal vein thrombosis (PVT) and superior mesenteric vein thrombosis. The patient received broad-spectrum IV antibiotics and full anticoagulation therapy with heparin and was discharged on oral Warfarin after completing 14-day antibiotic therapy. She presented again with recurrent watery diarrhea, fever, abdominal pain, and fatigue and was diagnosed with pylephlebitis and multiple small liver abscesses. The patient was treated with antibiotics for six weeks and was discharged on warfarin, furosemide, and spironolactone with close outpatient follow-up. Prolonged fever in COVID-19 patients can indicate extensive thrombosis at unusual sites, which can lead to major morbidity and mortality in patients.

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