Pylephlebitis-induced acute liver failure: A case report and review of literature

World J Hepatol. 2024 Jan 27;16(1):103-108. doi: 10.4254/wjh.v16.i1.103.


Background: Pylephlebitis is an extremely rare form of septic thrombophlebitis involving the portal vein, carrying high rates of morbidity and mortality.

Case summary: We present a case of a 42-year-old male with no past medical history who presented with acute onset of abdominal pain and altered mental status with laboratory tests demonstrating new-onset acute liver failure. Pylephlebitis was determined to be the underlying etiology due to subsequent workup revealing polymicrobial gram-negative anaerobic bacteremia and complete thrombosis of the main and left portal veins. To our knowledge, this is the first documented case of acute liver failure as a potential life-threatening complication of pylephlebitis.

Conclusion: Our case highlights the importance of considering pylephlebitis in the broad differential for abdominal pain, especially if there are co-existing risk factors for hypercoagulability. We also demonstrate that fulminant hepatic failure in these patients can potentially be reversible with the immediate initiation of antibiotics and anticoagulation.

Keywords: Acute liver failure; Case report; Gram negative anaerobic bacteremia; Portal vein thrombosis; Pylephlebitis; Septic thrombophlebitis.

Publication types

  • Case Reports