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Late polymicrobial transjugular intrahepatic portosystemic shunt infection in a liver transplant patient:A case report

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World Journal of Hepatology 2022年第4期14卷 846-853页

作者： Irene De La Caridad Perez Ziv J Haskal John I Hogan Curtis K Argo Department of Medicine University of Virginia Medical CenterCharlottesvilleVA 22903United States Department of Radiology and Medical Imaging Division of Vascular and Interventional RadiologyUniversity of Virginia Medical CenterCharlottesvilleVA 22903United States Department of Medicine Division of Infectious Diseases and International HealthUniversity of Virginia Medical CenterCharlottesvilleVA 22903United States Department of Medicine Division of Gastroenterology and HepatologyUniversity of Virginia Medical CenterCharlottesvilleVA 22903United States

BACKGROUND Infection of a transjugular intrahepatic portosystemic shunt(TIPS)stent is a rare and serious complication that most commonly occurs during TIPS creation and *** typically present with recurrent bacteremia due to shunt occlusion or *** date there are approximately 58 cases *** present a patient diagnosed with late polymicrobial TIPS infection five years following TIPS *** SUMMARY A 63-year-old female status-post liver transplant with recurrent cirrhosis and portal hypertension presented with sepsis and recurrent extended-spectrum betalactamase Escherichia coli *** tomography of the abdomen revealed an occluded TIPS with thrombus extension into the distal right portal vein,and focal thickening of the cecum and ascending *** revealed patchy ulcers in these areas with histopathology demonstrating ulcerated colonic mucosa with fibrinopurulent *** thrombectomy and revision revealed infected-appearing *** initially cleared her infection with antibacterial therapy and TIPS revision;however,soon after,she developed Enterobacter cloacae bacteremia and Candida glabrata and *** fungemia with recurrent TIPS *** remained on antifungal therapy indefinitely and later developed vancomycin-resistant Enterococcus faecium with recurrent TIPS *** option of liver re-transplant for removal of the infected TIPS was not offered given her critical illness and complex shunt *** patient became intolerant to linezolid and elected hospice *** Clinicians should be aware that TIPS superinfection may occur as long as five years following TIPS creation in an immunocompromised patient.

关键词： Transjugular intrahepatic portosystemic shunt endotipsitis Colitis Liver cirrhosis Liver transplantation Case report

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