Case Report


JAP  Volume 7 Issue 1


Figure 1: Helical CT scan of chest and abdomen post IV contrast, showing varying degrees of cavitations in both lungs


abscess develops, CT of the chest may show cavitating lesions. Blood cultures are mandatory in IV drug abusers (IVDU) who


present with DVT and fever. The most common sources of infection are the skin and oropharynx, and Staphylococcus aureus and Streptococci are the commonest organism.13 Management of septic deep venous thrombophlebitis and distant


emboli in IV drug users includes antibiotic therapy, anticoagulation, surgical intervention, and most importantly treatment of the source of infection. Empirical antibiotic therapy should cover gram positive, gram negative and anaerobic organisms until culture results are available.13


Community-acquired Methicillin-resistant-S.aureus


(MRSA) should also be considered in relevant areas. In patients with infective endocarditis, it is common practice to use IV antibiotics for at least four weeks. In those patients with pure septic DVT, antibiotics should continue for five to ten days while in those with distant emboli treatment should continue for two to six weeks. Duration of antibiotics treatment depends on clinical progression and improvement in inflammatory markers (CRP). Low molecular weight heparin (LMWH) is a convenient choice of anticoagulation because of benefits such as easy administration without the need for therapeutic monitoring. Oral anticoagulation with Warfarin may be difficult in IV drug users due to the difficulty in monitoring INR (due to poor venous access). Surgical interventions such as thrombectomy, ligation or resection of affected veins and draining of the abscesses should be considered after unsuccessful conservative therapy.


Conclusion The diagnosis of SPE is often challenging due to variation in


presentation. The recognition of SPE relies mainly on the presence


Dr Shyju Paremal Dr Paremal is a Registrar in Gastroenterology


and General Medicine at South Tyneside District Hospital in South Shields. He enjoys taking photos of landscapes and scenery, and is a fan of the UK’s coastlines and historic sites.


Dr Kumud Bhattarai Specialty doctor in Anaesthetics, Department of Critical Care, South Tyneside District Hospital.


Dr Sanjay Deshpande Consultant, Department of Anaesthesia, South Tyneside District Hospital.


Dr Oliver Schulte Consultant, Department of Radiology, South Tyneside District Hospital.


Figure 2: Abdominal CT scan showing thrombosis of right common femoral vein, external and common iliac vein, extending into mid IVC


of typical CT scan findings. It is also possible that SPE may be associated with various radiological features other than those it is currently associated with.14


Blood cultures, CT scan of the chest, and


echocardiography are imperative in the investigation of a patient presenting with suspected SPE. Early diagnosis, antimicrobial therapy, appropriate anticoagulation, and treating the source of infection, would lead in to resolution of the SPE in most of the cases. ■


JAP 2013: 1: 32-33 References


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