Pylephlebitis, or portal vein thrombus infection, is a rare condition that is often missed owing to the nonspecific nature of its signs and symptoms and an underappreciation of the clinical entity. Causative microbes are typically bacteria, although cases of candidal pylephlebitis have been described. Given the invasive technique required to culture the portal vein, antimicrobial selection typically relies on the assumption that the microbes isolated in blood culture are the same as those infecting the portal vein thrombus. We present a case of pylephlebitis in an immunocompetent patient with viridans streptococci and Bacteroides fragilis bacteremia subsequently found to have associated hepatic Candida abscesses. Our case highlights the need to proceed with caution when narrowing antimicrobial therapy for patients with pylephlebitis based on blood culture data alone. It also represents a rare exception to the teaching that hepatic Candida abscesses are only seen in individuals who are profoundly immunocompromised.
From the *Division of Infectious Diseases,
†Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City; and
‡Division of Infectious Diseases, Department of Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, NY.
Correspondence to: Lindsey B. Gottlieb, MD, Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1090, New York, NY 10029. E-mail: firstname.lastname@example.org.
The authors have no funding or conflicts of interest to disclose.