P1672 - A Gastrointestinal Variant of Lemierre’s Syndrome in a Young Healthy Patient With Plexiform Fibromyxoma

Ivy Zi Qian Liu, DO, MS, Meghan Cloutier, MD, Robert Ranger, MD, Jason Edwards, MD
University at Buffalo, Buffalo, NY

Introduction: Lemierre’s syndrome is a rare condition often occurring in young patients that is characterized by Fusobacterium bacteremia and septic emboli in the internal jugular vein after an oropharyngeal infection. We describe the case of a young patient with an abdominal variant of Lemierre’s syndrome in the setting of plexiform fibromyxoma (PF), a benign gastric mesenchymal tumor, in the gastric antrum. Given the rarity of cases of Lemierre’s associated with PF, it is important to evaluate cases for presentation and treatment approach.

Case Description/Methods: Patient is a 27 year old male with past medical history significant for IBS and previous gastric ulcer (seen 9/2023 on EGD) presenting for three weeks of abdominal pain, nausea, vomiting and fevers. He had a recent travel history of military deployment in Alaska with consumption of wild game while there. Patient was febrile and tachycardic with leukocytosis on admission. CT and MRI of the abdomen and pelvis showed a 7 cm long thrombus within the right main portal vein extending into the SMV. Two sets of blood cultures were positive for Fusobacterium necrophorum. A heparin drip and ertapenem were started.

Immunodeficiency, thrombophilia, autoimmune, myeloproliferative, leukemia, hepatitis, EBV, and CMV workup were negative. Subsequent PET scan demonstrated numerous abnormal areas of hypermetabolic activity in the portacaval region, periportal lymph nodes corresponding to the thrombus, as well as adenopathy at distant sites. EGD revealed 2.8 cm area of localized mucosal changes characterized by an area of subepithelial lesion with central crater proximal to the gastric antrum without a definitive ulcer. Colonoscopy was unremarkable. Endoscopic ultrasound biopsy of the lymph nodes and mass in gastric antrum showed PF, which is likely the point of entry for bacteria and cause of his thrombosis. Patient was treated with ertapenem for 6 weeks and apixaban for 3 months.

Discussion: Pylephlebitis, infective thrombophlebitis of the portal vein, is a rare complication of any abdominal or pelvic infection with a high morbidity and mortality. Due to non-specific symptoms on presentation, early recognition of pylephlebitis is often challenging. A multidisciplinary team approach to diagnose causes could improve outcomes. In addition, since PF is a rare tumor with a largely unknown pathogenesis, further studies are required to determine the link between PF and Lemierre’s.


Disclosures:


Ivy Zi Qian Liu, DO, MS, Meghan Cloutier, MD, Robert Ranger, MD, Jason Edwards, MD. P1672 - A Gastrointestinal Variant of Lemierre’s Syndrome in a Young Healthy Patient With Plexiform Fibromyxoma, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.