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A 50-year-old man with liver cirrhosis, Child B9, who received a transjugular intrahepatic portal shunt (TIPS) 3 years ago because of refractory ascites, presented with 24 hours of disorientation and bradypsychia associated with decompensated ascites. He developed grade II encephalopathy. His bilirubin was 0.77 mg/dL, his sodium was 132 mEq/L, and he has not acute alterations on liver enzymes. The C-reactive protein was 1.61 mg/dL, and the procalcitonin was 0.09 ng/mL. Urine, blood, and ascitic fluid cultures were obtained. Urine and ascites were not infected, but the blood cultures showed an Enterococcus faecium vancomycin sensitive. With the clinical suspicion of an endotipsitis-associated bacteremia, we requested a positron emission tomography/computed tomography scan. The images showed (a) in the coronal and (b) in the axial sections a hypercaptation in the TIPS with a maximum Standarized Uptake Value of 5.3 uCi/mL, which was compatible with endotipsitis. The patient presented a good evolution with vancomycin and oral linezolid. TIPS is commonly used for the decompression of portal pressure. Bacteremia associated with the endovascular infection of TIPS is a rare but a serious complication, difficult to diagnose because of the impossibility of removing the stent. A positron emission tomography/computed tomography scan could be a useful noninvasive tool to improve the diagnosis procedure. (Informed consent was obtained from the patient to publish these images.

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