No abstract

Myeloproliferative neoplasms such as essential thrombocythemia (ET) have been associated with glomerular disease on rare instances. A case of ET associated with immunoglobulin A nephropathy (IgAN) is described in a 57-year-old man with a history of hypertension. Progressively worsening renal function was noted in the patient along with unexplained mild thrombocytosis. Pathological review of renal biopsy identified IgAN concurrently with newly diagnosed JAK2-mutated ET. The patient was started on aspirin therapy and closely monitored for his renal function. A literature review of the association of ET and renal disease revealed nine cases of ET associated with IgAN, focal segmental glomerulosclerosis, and fibrillary glomerulonephritis. Comparison of the pathological features of the renal biopsies within the cases noted mesangial proliferation as a common finding, which has been described to be potentiated by platelet-derived growth factor (PDGF). This commonality may represent a link between ET and glomerular disease which deserves further attention in future cases. Improved management of such cases depends on the recognition of the combined occurrence of ET and glomerular diseases and uncovering the shared pathogenesis between platelets and glomeruli.

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Acute portal vein thrombosis represents a less common type of venous thromboembolism, even among the prothrombotic complications of coronavirus disease 2019 (COVID-19). Such complications are primarily reported during the active phase of infection. The case here describes acute portal vein thrombosis following resolution of COVID-19 in a 44-year-old male who presented with abdominal pain. Abdominal imaging identified portal and other splanchnic vein thromboses. Studies for hypercoagulable conditions were negative. Polymerase chain reaction was negative for severe acute respiratory syndrome coronavirus-2; however, IgG serology was positive. The case highlights the importance of considering thrombotic complications, particularly splanchnic vein thromboses, in patients with recent COVID-19.

Suppurative thrombophlebitis of the portal vein, or pylephlebitis, is a rare infectious manifestation. Only few cases resulting from Fusobacterium species have been reported, demonstrating the disease that is in some ways analogous to Lemierre's syndrome, or suppurative thrombophlebitis of the internal jugular vein. Of these, Fusobacterium nucleatum represents an important subtype with unique colon cancer risk. With high mortality rates up to 32% being described in the past, prompt identification and treatment of pylephlebitis is necessary to avoid poor outcomes with this condition, including complications such as intestinal ischemia and portal hypertension. This condition typically presents alongside bacteremia, for which antibiotic therapy typically targets anaerobic organisms of oral and intestinal mucosa, as well as Streptococcus species. The use of anticoagulation therapy for pylephlebitis is supported by limited data, which shows potential benefit for preventing worsening thrombosis and liver atrophy. Here we present a case of F. nucleatum pylophlebitis who presented with related bacteremia and liver abscess after a dental infection, and treated with anaerobic coverage antibiotics including amoxicillin clavulanate until resolution of his hepatic abscess and with anticoagulation with apixaban for a total of 6 months.