Pyrexia of unknown origin: inferior vena cava agenesis

A 26-year-old woman presented with a 5-day history of fever after returning from Bali. She denied sexual contact abroad. On examination, there was suprapubic tenderness and a widespread maculopapular rash. Malaria serology was negative and blood tests were normal except for an elevated C reactive pr...

Full description

Saved in:
Bibliographic Details
Published in:BMJ case reports 2018-06, Vol.2018, p.bcr-2018-224739
Main Authors: Thein, Onn Shaun, Braganza Menezes, Darryl A, Moran, Ed
Format: Article
Language:English
Subjects:
Abdomen
Abscesses
Antibiotics
Anticoagulants
Case reports
Congenital diseases
Coronary vessels
Family medical history
Fever
Gynecology
Hematology
Molecular weight
Pain
Patients
Population
Thromboembolism
Thrombosis
Unusual Association of Diseases/Symptoms
Veins & arteries
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:A 26-year-old woman presented with a 5-day history of fever after returning from Bali. She denied sexual contact abroad. On examination, there was suprapubic tenderness and a widespread maculopapular rash. Malaria serology was negative and blood tests were normal except for an elevated C reactive protein. Treatment was initially with ceftriaxone, metronidazole and doxycycline, but her symptoms failed to improve. A CT pelvis suggested a possible tubo-ovarian abscess, a suspected inferior vena cava (IVC) anomaly and left internal iliac/femoral venous thrombosis. A gynaecology review demonstrated left tubo-ovarian tenderness and fullness. An MRI suggested pelvic inflammatory disease and thrombophlebitis affecting the pelvic veins; deep vein thrombosis (DVT) treatment was commenced. Further family history revealed thrombosis throughout multiple generations. Further imaging analysis demonstrated agenesis of the IVC with compensatory dilation of pelvic collaterals and an acute DVT of the deep pelvic venous system. The patient was discharged with direct oral anticoagulant therapy.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2018-224739