Recurrent bacteraemia following variceal haemorrhage

A 43-year-old man presented to the hospital with septic shock. Eight weeks prior, he had experienced recurrent gastric variceal bleeding (figure 1), treated initially with cyanoacrylate glue injection. Abdominal CT scan suggested features of chronic liver disease, with non-alcoholic fatty liver disease being the presumed aetiology. Despite endoscopic therapy, he had further variceal haemorrhage, and was treated successfully with insertion of a transjugular intrahepatic portosystemic stent shunt (TIPSS) (covered stent). Other past medical history included ulcerative colitis, antiphospholipid syndrome (treated with warfarin) and splenectomy. Figure 1 Gastroscopy demonstrating gastric varices. On physical examination, there was no obvious source of infection. Laboratory investigations demonstrated a white blood cell count of 18.4×109/l, haemoglobin of 106 g/L, C-reactive protein of 195 mg/L and international …