Perez Irene Caridad, Haskal Ziv J, Hogan John I, Argo Curtis K
Department of Medicine, University of Virginia Medical Center, Charlottesville, VA 22903, United States.
Department of Radiology and Medical Imaging, Division of Vascular and Interventional Radiology, University of Virginia Medical Center, Charlottesville, VA 22903, United States.
World J Hepatol. 2022 Apr 27;14(4):846-853. doi: 10.4254/wjh.v14.i4.846.
Infection of a transjugular intrahepatic portosystemic shunt (TIPS) stent is a rare and serious complication that most commonly occurs during TIPS creation and revision. Patients typically present with recurrent bacteremia due to shunt occlusion or vegetation. To date there are approximately 58 cases reported. We present a patient diagnosed with late polymicrobial TIPS infection five years following TIPS creation.
A 63-year-old female status-post liver transplant with recurrent cirrhosis and portal hypertension presented with sepsis and recurrent extended-spectrum beta-lactamase bacteremia. Computed 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 colon. Colonoscopy revealed patchy ulcers in these areas with histopathology demonstrating ulcerated colonic mucosa with fibrinopurulent exudate. Shunt thrombectomy and revision revealed infected-appearing thrombus. Patient initially cleared her infection with antibacterial therapy and TIPS revision; however, soon after, she developed bacteremia and and fungemia with recurrent TIPS thrombosis. She remained on antifungal therapy indefinitely and later developed vancomycin-resistant with recurrent TIPS thrombosis. The option of liver re-transplant for removal of the infected TIPS was not offered given her critical illness and complex shunt anatomy. The patient became intolerant to linezolid and elected hospice care.
Clinicians should be aware that TIPS superinfection may occur as long as five years following TIPS creation in an immunocompromised patient.
经颈静脉肝内门体分流术（TIPS）支架感染是一种罕见且严重的并发症，最常发生在TIPS创建和修复过程中。患者通常因分流闭塞或赘生物而出现反复菌血症。迄今为止，大约有58例相关病例报道。我们报告一例在TIPS创建五年后被诊断为晚期多微生物TIPS感染的患者。
一名63岁女性，肝移植术后，患有复发性肝硬化和门静脉高压，出现败血症和反复的产超广谱β-内酰胺酶菌血症。腹部计算机断层扫描显示TIPS闭塞，血栓延伸至右门静脉远端，盲肠和升结肠局灶性增厚。结肠镜检查显示这些区域有散在溃疡，组织病理学显示结肠黏膜溃疡伴纤维脓性渗出物。分流血栓切除术和修复显示血栓有感染迹象。患者最初通过抗菌治疗和TIPS修复清除了感染；然而，不久后，她又出现了菌血症和真菌血症，同时伴有TIPS反复血栓形成。鉴于她病情危重且分流解剖结构复杂，未提供肝再次移植以移除感染的TIPS这一选择。患者对利奈唑胺不耐受，选择了临终关怀。
临床医生应意识到，在免疫功能低下的患者中，TIPS创建后长达五年可能会发生TIPS二重感染。
