# Pylephlebitis and Right-Sided Endocarditis: A Rare Complication of an Intra-abdominal Infection

## TL;DR

This case report describes a rare complication of intra-abdominal infection leading to pylephlebitis and right-sided endocarditis caused by S. gallolyticus in a patient with a history of rectal cancer.

## Contribution

The paper highlights the rare association of pylephlebitis and right-sided endocarditis caused by S. gallolyticus in a patient with a history of rectal cancer.

## Key findings

- The patient was diagnosed with S. gallolyticus-mediated tricuspid valve endocarditis.
- Pylephlebitis was identified as an underlying complication of an intra-abdominal infection.
- No evidence of pacemaker lead endocarditis was found despite fever episodes post-implantation.

## Abstract

Right-sided infective endocarditis is less common than left-sided endocarditis and can be a difficult clinical diagnosis. The presence of intracardiac devices is a major risk factor. The presentation is less clear than left-sided forms because of the presence of respiratory symptoms and the absence of systemic embolization. Pylephlebitis, or septic thrombosis of the portal vein, is a serious infectious condition that often delays diagnosis. It is a complication of intraabdominal or pelvic infections. Streptococcus gallolyticus (S. gallolyticus) can cause infective endocarditis and is associated with colon neoplasia and hepatobiliary disease.

In this case report, we describe the case of a 76-year-old male with a history of rectal adenocarcinoma who presented with different episodes of fever of unknown origin (FUO), one of which occurred after pacemaker implantation. Ultimately, he was diagnosed with S. gallolyticus-mediated tricuspid valve endocarditis with underlying pylephlebitis. Investigations did not show evidence of pacemaker lead endocarditis.