acenocoumarol and Jaundice

Pylephlebitis is the septic thrombosis of the portal vein. Hypercoagulability and intra-abdominal sepsis are the main predisposing factors. A 25-year-old man presented to a primary health care center complaining of fever, epigastric pain, and jaundice. He was initially diagnosed with a gastrointestinal infection and alcoholic hepatitis and, due to his unstable clinical status, was referred to the emergency room. A diagnosis of acute pylephlebitis complicated with septic shock was made. Treatment with a wide-spectrum antibiotic and anticoagulation was initiated. Fifteen days later, recanalization of the portal vein was achieved and clinical status was improved. Pylephlebitis following gastrointestinal infection is a potential cause of septic shock.

Topics: Acenocoumarol; Acute Disease; Adult; Anti-Bacterial Agents; Anticoagulants; Bacteremia; Escherichia coli Infections; Heparin; Humans; Jaundice; Male; Phlebitis; Portal Vein; Radiography; Shock, Septic; Ultrasonography; Venous Thrombosis

A 69-year-old man developed cholestatic liver enzyme disturbances three and a half weeks after starting treatment with acenocoumarol because of a deep venous thrombosis in his leg. Serological testing showed no signs of recent viral infections. A presumptive diagnosis of hepatotoxicity caused by the use of acenocoumarol was made and the anticoagulant was replaced by low molecular weight heparin. Three weeks after withdrawal of the acenocoumarol, the enzymes had improved. The patient made a full recovery within two months. This case suggests a causal relationship between acenocoumarol exposure and liver damage.

Topics: Acenocoumarol; Aged; Anticoagulants; Diagnosis, Differential; Follow-Up Studies; Humans; Jaundice; Liver; Liver Function Tests; Male; Thrombophlebitis