Septic Thrombophlebitis of the Portal Vein

SIRWe read with interest the article by Plemmons et al. [1]. We treated a patient who had pylephlebitis associated with appendicitis. A 38-year-old woman without a medical or surgical history presented with complaints of vomiting, diarrhea, fever, and rigors. Results ofthe initial physical examination were normal. Laboratory studies showed a WBC count of 5,500/mm (89% segmented neutrophils), a platelet count of 84,000/mm , and normal liver function. The patient received therapy with oral amoxicillin and then with oral ofloxacin; there was no effect on her fever and diarrhea. Eight days after the onset of symptoms, she was admitted to the hospital. Fever persisted (temperature to 40°C) and was associated with intermittent confusion. Physical examination revealed tenderness of the right upper quadrant. There was no meningism or focal neurological defects. A lumbar puncture was performed, and results of CSF analysis were normal. Liver function tests showed cholestasis with an alkaline phosphatase level of 200 U/L (normal level, <90 U/L) and a