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Case report
Endotipsitis: a rare case of endovascular infection with ESBL Klebsiella pneumoniae
  1. Andrei Schwartz1,
  2. Aayushi Garg2,
  3. Giselle Statz1 and
  4. Justin Smock1
  1. 1Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  2. 2Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  1. Correspondence to Dr Andrei Schwartz; sch.andrei{at}


Endotipsitis is a vegetative endovascular infection of a transjugular intrahepatic portosystemic shunt (TIPS). There is currently no uniformly accepted diagnostic criterion, and most cases are diagnosed by clinical diagnosis of recurrent bacteraemia in patients with TIPS and no identifiable source after appropriate investigation. We present a case of 62-year-old man in whom endotipsitis was suspected clinically after emergent TIPS placement complicated by TIPS thrombosis, need for TIPS revision and recurrent bacteraemia. The diagnosis was confirmed using an Indium-111-labelled leucocyte scan (tagged white blood cell scan). This case highlights the potential risks of endotipsitis with TIPS procedures and provides insight into the utilisation of an old diagnostic tool in a new diagnostic role.

  • nosocomial infections
  • radiology

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  • Contributors Conception of the case report and writing of the manuscript by AS, literature review performed by GS. AG helped with the planning and writing of the manuscript, the project was supervised by JS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.