Identification and Management Implications of Fusobacterium Nucleatum Pylephlebitis

Abstract

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.