Methods:-
For those symptoms septic workup which included CBC, CRP, Blood culture
and sensitivity, urinalysis and culture, Lumbar puncture was done and
broad spectrum antibiotics started(piperacillin-tazobactam and
amikacin). Ultrasound of the abdomen and pelvis was also ordered which
demonstrated incidental left portal vein thrombosis(figure-1) The
laboratory reports showed Total leucocytes count of 12700/μl with 24%
Neutrophils and 70 % lymphocytes, platelets was 39500/μl, hemoglobin
11.8 gm/dl, CRP-5.7 mg/dl, PT/iNR- 10/1 sec, APTT- 24 sec, urine
analysis showed normal findings and urine culture was sterile. Initial
blood was sterile, however repeated blood culture after 1 week showed
growth of Acinetobacter baumannii , which was sensitive to
amikacin, gentamicin, doxycycline, ciprofloxacin, TMP-SMX and colistin
and resistant to piperacillin-tazobactam, ceftriaxone, cefepime, so
antibiotic changed accordingly. Repeated ultrasound on the 7th day still
showed the thrombus in the portal vein. Treatment with enoxaparin
started, and weekly Ultrasound was done to see regression of thrombus.