Portal Vein Thrombosis: A Saga of two Nebulous Etiologies

Portal Vein Thrombosis (PVT) is the most prevalent cause of extrahepatic portal vein obstruction. Cirrhosis, inherited procoagulant conditions (such as Factor V Leiden, Antithrombin III deficiency, etc.), myeloproliferative neoplasms, hepatocellular carcinoma and operative manipulation of the portal vein are all common causes of portal vein thrombosis. Even though a diagnosis is usually made, more than 25% of patients have no clear explanation for their PVT. The authors describe two cases of portal vein thrombosis in an atypical setting-one in a middle-aged female with type 2 diabetes mellitus with pyoperitoneum and the other is in a young male coinfected with human immunodeficiency virus and hepatitis E virus. Both cases had very different outcomes and thus emphasized the notion that PVT is a potentially fatal condition demanding a thorough diagnostic workup and evaluation.