化脓性盆腔血栓性静脉炎(SPT)是一种罕见的疾病,在盆腔静脉形成血栓,通常是卵巢静脉,随后感染和炎症。我们介绍了一例右卵巢静脉血栓形成(ROVT),耐甲氧西林金黄色葡萄球菌(MRSA)菌血症,和SPT症状的延迟发作,需要组织纤溶酶原激活剂。一个40岁的女人,G3P2,妊娠38周时,因39°C发烧入院。她患有宫颈机能不全,经常卧床休息。血培养显示MRSA,计算机断层扫描显示大的ROVT。她接受了万古霉素和直接口服抗凝剂,她的发烧在第三天就解决了.在第16天,发烧复发,ROVT严重疼痛。第二次计算机断层扫描显示静脉壁增厚,ROVT周围增强,与SPT一致。尽管使用DOAC和抗菌药物治疗,但疼痛和发烧逐渐加剧,分别在第23天和第25天开始服用肝素和组织纤溶酶原激活剂.随着到第29天血栓形成的再通,发烧和腹痛得以缓解。我们经历了一例与MRSA菌血症和大ROVT相关的延迟性SPT。MRSA菌血症可能导致原本存在的ROVT成为感染源,导致症状反复发作和长期治疗的SPT。早期和严格的抗凝对于大量血栓形成和菌血症的病例至关重要。由于进展为SPT的高风险。该病例强调了再通对SPT治疗的重要性以及组织纤溶酶原激活剂对大量血栓形成的有用性。
Septic pelvic thrombophlebitis (SPT) is a rare condition that forms thrombosis in the pelvic veins, typically the ovarian veins, with subsequent infection and inflammation. We present a
case of right ovarian vein thrombosis (ROVT), methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, and delayed onset of SPT symptoms, requiring tissue-plasminogen activator. A 40-year-old woman, G3P2, at 38 weeks\' gestation, was admitted with a fever of 39°C. She had cervical insufficiency and had been often on bed rest. Blood culture revealed MRSA and computed tomography revealed a large ROVT. She received vancomycin and direct oral anticoagulant, and her fever resolved by day 3. On day 16, fever recurred with severe pain over the ROVT. Second computed tomography showed thickening of venous wall with enhancement around ROVT, consistent with SPT. Since pain and fever gradually exacerbated despite treatment with DOAC and antimicrobials, she was started on heparin and tissue plasminogen activator on days 23 and 25, respectively. Along with recanalization on the thrombosis by day 29, fever and abdominal pain resolved. We experienced a
case of delayed onset SPT associated with MRSA bacteremia and a large ROVT. MRSA bacteremia might cause the originally existing ROVT to become an infection source, resulting in SPT with recurrent symptoms and long-term treatment. Early and strict anticoagulation is crucial in cases with a large thrombosis and bacteremia, due to the high risk of progression to SPT. This
case highlights the importance of recanalization for the treatment of SPT and usefulness of administration of tissue-plasminogen activator for the massive thrombosis.