Case of thrombosis of the portal vein and its branches in a patient seropositive for Borrelia antigens


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Abstract

Borreliosis after sucking ticks is an acute problem in the world. People do not go to doctors after that often, which leads to the development of various complications. Thrombosis of veins of various localization can be one of them. Thrombosis of the portal vein represents a significant problem too with high morbidity and mortality. The risk factors for splanchnic vein thrombosis include infections, but its relationship with borreliosis has not been studied. А 34-year-old man with chronic helicobacter-associated gastritis and gallstones was hospitalized due to development during the last 11 days of epigastric pain and fever to 38.7 °C after a picnic at the forest without a registered tick bite. The blood leukocytes were increased to 11.2*109/l, lymphocytes 70%, C-reactive protein 34.6 mg/l, procalcitonin 0.195 ng/ml. The multispiral computed tomography of the abdominal cavity revealed thrombosis of portal, lienalis and superior mesenteric veins. D-dimer was 1.98 mcg/ml, antithrombin III 75%. JACK2V617F, oncological, rheumatic, thrombophilia markers, blood and urine cultures were negative. A high concentration of anti-Borrelia burgdorferi IgM 62.2 U/ml and its increasing to 190 U/ml in dynamics was revealed at the immunofluorescence assay. Anti-Borrelia IgM to OspA, p31 and OspC, p25 were detected at the immunoblotting assay. Anticoagulation, doxycycline, detoxification therapy reduced pain and normalized temperature and inflammation markers. Vein thrombosis was not detected at the control tomography after 2 weeks. Despite that the combination of thrombosis and borreliosis is rare, it is necessary to screen for Borrelia antigens in patients with splanchnic vein thrombosis and fever.

About the authors

E V Reznik

N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation; V.M. Buyanov City Clinical Hospital

Email: elenaresnik@gmail.com
д.м.н., проф. каф. госпитальной терапии №2 ФГБОУ ВО «РНИМУ им. Н.И. Пирогова», ORCID http://orcid.org/0000-0001-7479-418X; ResearcherIDN-6856-2016 Moscow, Russia

M P Prushkovskaya

Central Clinical Hospital

зав. 5-м терапевтическим отд-нием ЦКБ РАН Moscow, Russia

E D Presnova

N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation

соискатель каф. госпитальной терапии №2 ФГБОУ ВО «РНИМУ им. Н.И. Пирогова» Минздрава РФ Moscow, Russia

N A Novikova

Central Clinical Hospital

к.м.н., врач-терапевт 5-го терапевтического отд-ния ЦКБ РАН Moscow, Russia

R A Ivaschenko

V.M. Buyanov City Clinical Hospital

врач рентгенологического отд-ния ГБУЗ «ГКБ им. В.М. Буянова» ДЗМ Moscow, Russia

E I Dedov

N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation; Central Clinical Hospital

д.м.н., проф. каф. госпитальной терапии №2 ЛФ ФГБОУ ВО «РНИМУ им. Н.И. Пирогова» Минздрава РФ; зам. главного врача ЦКБ РАН Moscow, Russia

A E Nikitin

Central Clinical Hospital

д.м.н., проф., главный врач ЦКБ РАН Moscow, Russia

I G Nikitin

N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation

д.м.н., проф., зав. каф. госпитальной терапии №2 ФГБОУ ВО «РНИМУ им. Н.И. Пирогова» Минздрава РФ Moscow, Russia

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