Septic deep venous thrombophlebitis and distant emboli in injecting drug users – treatment experience and outcome

Abstract

Injecting drug use is a world-wide problem responsible for numerous minor and major complications which are well recognised. After years of injecting drug use, superficial and peripheral veins may become obliterated and the committed drug user attempts to inject drugs into proximal and more central veins. Besides the potential for mechanical and toxic complications such as vascular injury, intra-arterial drug injection, pneumothoraces, mycotic aneurysms and deep abscess formation, use of large proximal veins may result in life threatening septic deep vein thrombophlebitis.^{1, 2, 5}

Aseptic and septic thrombophlebitis of peripheral veins is a well recognised complication of intravenous catheters and usually responds to removal of the intravascular device. Catheter related septic thrombophlebitis of proximal large veins and great central veins are also widely reported. However septic or suppurative thrombophlebitis of deep veins in IDUs characterised by micro abscess formation within the thrombotic veins and repeated bacterial embolisation into the circulation, is a severe systemic disease which has received little attention in the literature.^{1, 3}

We recently observed ten IDUs (11 episodes) with septic DVT admitted to the infectious diseases unit in Fife, Scotland within a period of 28 months. This report summarises our experience in the diagnosis,treatment and follow-up of these patients.