VEGETATIVE INFECTION OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNTS

Background & Aims:The occurrence of and the clinical picture of infect ion of transjugular intrahepatic portosystemic shunts (TIPS) has not b een described previously, We describe the clinical features, associate d pathogens, results of treatment of a previously unreported complicat ion of TIPS, and primary infection of TIPS occurring after formation o f the neointima, Methods: Patients with TIPS and fever were evaluated to exclude other sources of infection. The diagnosis was based on the occurrence of fever with positive blood cultures and either a thrombus or vegetations on the stent or persistent bacteremia in a patient wit h a TIPS and no other detectable source of infection despite an extens ive search. Results: Eight patients met diagnostic criteria. Two of 8 cases occurred within 10 days of TIPS manipulation despite antibiotic administration before the procedure. The clinical features included fe ver (8 patients), tender hepatomegaly (5 of 8), hypoxemia (2 of 8), se ptic pulmonary emboli (1 of 8), septic shock (2 of 8), neutrophilia (5 of 8), and subsequent development of necrotizing fasciitis (1 of 8), Blood cultures were positive in all cases, The organisms included oral and enteric aerobic gram-negative bacteria in 7 of 8 patients and Can dida in 1 patient, All 8 responded to administration of antibiotics, T wo patients died of myocardial infarction and alcoholic hepatitis, res pectively. Conclusions: Infective endotipsitis is an uncommon complica tion of TIPS, Recognition of its clinical features will facilitate dia gnosis, Most patients responded to antibiotic therapy.