Fusobacterium-Associated Pylephlebitis Complicated by Hepatic Abscess Following Roux-en-Y Gastric Bypass Surgery–Gastrointestinal Variant of Lemierre Syndrome: A Case Report

This report describes a rare case of acute pylephlebitis complicated by hepatic abscess formation secondary to Fusobacterium nucleatum. The patient is a 48-year-old woman who presented with worsening abdominal pain and malaise for 3 weeks. She had a Roux-en-Y gastric bypass surgery 4 months earlier that showed a phlegmon at the surgical site on a contrast computed tomography scan postsurgery. Physical examination revealed right upper quadrant tenderness, and magnetic resonance imaging of the liver showed portal vein thrombosis with multiple hepatic abscesses. The patient was started empirically on cefepime and metronidazole. A tagged white blood cell scan showed an infected portal vein thrombosis. The abscess was aspirated and grew F. nucleatum. The patient was discharged on rivaroxaban and a 6-week course of ceftriaxone and metronidazole. The pathophysiology of acute pylephlebitis is hematogenous dissemination into the portal system from a remote enteric infection. Fusobacterium nucleatum is a commensal anaerobe in the oral cavity, but emerging evidence suggests that it can also colonize the gastrointestinal mucosa and can lead to pylephlebitis and hepatic abscess. In the literature, only a handful of Fusobacterium pylephlebitis complicated by hepatic abscess have been reported. This is the first known case of Fusobacterium-associated pylephlebitis complicated by hepatic abscess post–Roux-en-Y gastric bypass surgery.
Source: Infectious Diseases in Clinical Practice - Category: Infectious Diseases Tags: Case Reports Source Type: research

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