Portal vein thrombosis (PVT) is a rare disease with an incidence of 0.7/100,000 inhabitants per year. Septic PVT (pylephlebitis) usually occurs secondary to infection in the anatomic region drained by the portal venous system. We report on a 76-year-old German male who was admitted with a history of recurrent fever and acute renal failure. Blood cultures taken on admission showed Escherichia coli, as well as Bacteroides uniformis after an extended incubation period of 90 h. In addition, infection with Leptospira spp. was diagnosed serologically. Computerized tomography of the abdomen revealed an extensive PVT along with signs of colonic diverticulitis. Symptoms resolved under prolonged antimicrobial therapy with beta-lactams and adequate heparinization. A myeloproliferative disorder could be excluded. There was no evidence of an underlying coagulation disorder. Imaging controls showed an almost complete resolution of the PVT after 6 months of anticoagulation therapy. To the best of our knowledge, this is the first report of such an “unhappy triad,” which includes atypical manifestations of leptospirosis and involvement of other intestinal bacteria.
Case Rep Gastroenterol 2021;15:598–602

中文翻译：

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不愉快的三联征：钩端螺旋体感染。与门静脉血栓形成异常表现相关的大肠杆菌和均匀拟杆菌

门静脉血栓形成 (PVT) 是一种罕见的疾病，每年的发病率为 0.7/100,000 居民。脓毒性 PVT（门静脉炎）通常继发于门静脉系统引流的解剖区域的感染。我们报告了一名 76 岁的德国男性，他因反复发烧和急性肾功能衰竭入院。入院时采集的血培养显示大肠杆菌，以及延长 90 小时潜伏期后的均匀拟杆菌。此外，钩端螺旋体感染属 经血清学诊断。腹部计算机断层扫描显示广泛的 PVT 以及结肠憩室炎的迹象。症状在长期使用 β-内酰胺类抗生素和充分肝素化的抗菌治疗后得到缓解。可以排除骨髓增殖性疾病。没有证据表明存在潜在的凝血障碍。在抗凝治疗 6 个月后，影像控制显示 PVT 几乎完全消退。据我们所知，这是此类“不愉快的三联征”的首次报告，其中包括钩端螺旋体病的非典型表现和其他肠道细菌的参与。
Case Rep Gastroenterol 2021；15:598–602