title: Recurrent bacteremia after injection of N-butyl-2-cyanoacrylate for treatment of bleeding gastric varices: a case report and review of the literature.
abstract: BACKGROUND
  Bleeding from gastric varices has high mortality rate, and obliteration using N-butyl-2-cyanoacrylate is the treatment of choice. Recurrent bacteremia is rarely reported following the procedure. We aimed to report a case of recurrent bacteremia after N-butyl-2-cyanoacrylate treatment and to review published cases.
  In May 2014, a 43-year-old Brazilian male presented with lower gastrointestinal bleeding. Endoscopy showed active bleeding from gastric varix. Injection of N-butyl-2-cyanoacrylate was performed and the patient was discharged. Over the next 4 months he presented with three episodes of bacteremia with severe sepsis and no identifiable focus of infection. Oral prophylaxis was initiated in September 2014 and he has remained free of bacteremia. Six other cases of recurrent bacteremia following sclerosis with N-butyl-2-cyanoacrylate were reported in the literature. All patients had portal hypertension and bleeding from gastric varices. Average age of patients was 55.7 years and the median time from endoscopic procedure to the first episode of bacteremia was 105 days (range 14-365). The mean number of episodes of bacteremia per patient was 2.5.
  
  
  CONCLUSIONS
  Recurrent bacteremia associated with endoscopic treatment with N-2-butyl-cyanoacrylate is rare, but should be suspected in patients in which investigation shows no other focus of infection. Secondary prophylaxis should be considered after the first episode.
authors.affiliation: Division of Infectious and Parasitic Diseases, Clinical Hospital, University of São Paulo Medical School, Dr. Ovídio Pires de Campos Street, 225-Cerqueira César, São Paulo, SP, 05403-010, Brazil. bruno_randi@yahoo.com.br.
authors.forename: Bruno A
authors.initials: BA
authors.lastname: Randi
authors.affiliation: Division of Infectious and Parasitic Diseases, Clinical Hospital, University of São Paulo Medical School, Dr. Ovídio Pires de Campos Street, 225-Cerqueira César, São Paulo, SP, 05403-010, Brazil. danielayabe@gmail.com.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Ninomiya
authors.affiliation: Division of Infectious and Parasitic Diseases, Clinical Hospital, University of São Paulo Medical School, Dr. Ovídio Pires de Campos Street, 225-Cerqueira César, São Paulo, SP, 05403-010, Brazil. elisabeth.nicodemo@hc.fm.usp.br.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Nicodemo
authors.affiliation: Department of Gastroenterology, University of São Paulo School of Medicine, Dr. Ovídio Pires de Campos Street, 225-Cerqueira César, São Paulo, SP, 05403-010, Brazil. bbclopes@yahoo.com.br.
authors.forename: Beatriz C
authors.initials: BC
authors.lastname: Lopes
authors.affiliation: Department of Gastroenterology, University of São Paulo School of Medicine, Dr. Ovídio Pires de Campos Street, 225-Cerqueira César, São Paulo, SP, 05403-010, Brazil. eduardocancado@usp.br.
authors.forename: Eduardo R
authors.initials: ER
authors.lastname: Cançado
authors.affiliation: Division of Infectious and Parasitic Diseases, Clinical Hospital, University of São Paulo Medical School, Dr. Ovídio Pires de Campos Street, 225-Cerqueira César, São Paulo, SP, 05403-010, Brazil. anna@usp.br.
authors.forename: Anna S
authors.initials: AS
authors.lastname: Levin
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods; D016470:Bacteremia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D002443:Ceftriaxone / Q000627:therapeutic use; D004659:Enbucrilate / Q000008:administration & dosage / Q000009:adverse effects*; D004932:Esophageal and Gastric Varices / Q000188:drug therapy*; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy; D006801:Humans; D007267:Injections; D008297:Male; D012008:Recurrence; D034366:Streptococcus anginosus / Q000187:drug effects / Q000302:isolation & purification*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D004659:Enbucrilate