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.