Identification and Management Implications of Fusobacterium Nucleatum Pylephlebitis

Abstract

Suppurativethrombophlebitis of the portal vein, or pylephlebitis, is a rare infectious manifestation. Only few casesresulting from Fusobacterium species have been reported, demonstratingthe disease that is in some ways analogous to Lemierre’s syndrome, orsuppurative thrombophlebitis of the internal jugular vein. Of these, Fusobacteriumnucleatum represents an important subtype with unique colon cancer risk.With high mortality rates up to 32% being described in the past, promptidentification and treatment of pylephlebitis is necessary to avoid pooroutcomes with this condition, including complications such as intestinalischemia and portal hypertension. This condition typically presents alongsidebacteremia, for which antibiotic therapy typically targets anaerobic organismsof oral and intestinal mucosa, as well as Streptococcus species. The useof anticoagulation therapy for pylephlebitis is supported by limited data,which shows potential benefit for preventing worsening thrombosis and liveratrophy. Here we present a case of F. nucleatum pylophlebitis whopresented with related bacteremia and liver abscess after a dental infection,and treated with anaerobic coverage antibiotics including amoxicillinclavulanate until resolution of his hepatic abscess and with anticoagulationwith apixaban for a total of 6 months.