EC Gastroenterology and Digestive System

Background: Septic pylephlebitis, also known as septic thrombophlebitis of the portal vein, is an extremely rare and dangerous complication of Crohn's disease (CD). Diagnosis can be difficult in the absence of suggestive clinical context.

Observation: In this report, we present a case of a 43-year-old patient with well-controlled colonic Crohn's disease who was treated with mesalamine. The patient developed fever, chills, and sweats following geophagy. These symptoms are accompanied by acute abdominal pain. Upon clinical examination, the patient was febrile at 39.5°C and had epigastric tenderness. Biological assessments revealed an inflammatory syndrome, including hyperleukocytosis, anemia, and a biological inflammatory syndrome. Abdominal CT scan (CT) revealed massive thrombosis in the portal vein without any signs of intra-abdominal infection. Blood cultures tested positive for Streptococcus viridians. The tests for deep vein thrombosis, pulmonary embolism, and thrombophilia yielded negative results. The patient was successfully treated with antibiotics and anticoagulants for septic pylephritis in Crohn's disease.

Conclusion: This case highlights the importance of early comprehensive evaluation for immediate diagnosis and appropriate treatment of septic pylephlebitis in patients with CD presenting with fever and abdominal pain of unknown origin. To our knowledge, this is the first report of an association between pylephlebitis and geophagia.

 Keywords: Septic Thrombophlebitis; Crohn Disease; Pica; Portal Vein

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