A middle aged patient with a hx of cirrhosis secondary to autoimmune hepatitis on azathioprine and prednisone who presented with acute on chronic abdominal pain called to the ED for Gram Negative bacteremia. CT abdomen demonstrated thrombi within the peripheral branches of the portal venous system consistent with pylephlebitis. The patient was treated with antibiotics and the decision was made to not anticoagulate.
-Anticoagulation for pylephlebitis is NOT recommended unless there is evidence of progression of thrombosis or fever or bacteremia despite antibiotic therapy
-The most common predisposing infections leading to pylephlebitis are diverticulitis and appendicitis.