Repetitive episodes of cryptogenic septicaemia in a patient with cirrhosis: a case of "heavy metal".

Endotipsitis or primary infection of a TIPS-stent, is an uncommon but possible life- threatening condition by its potential evolution to sepsis and death. Diagnosis should be suspected in patients with a TIPS-stent presenting with stent-dysfunction associated with fever or relapsing episodes of bacteremia/sepsis without any other alternative focus. A certain diagnosis is made by post-factum histopathological and/or microbiological examination of the TIPS-stent which is only possible after liver transplantation or at autopsy, whereas it can be highly suspected in case of repetitive positive blood-cultures without any other focus in a patient with a TIPS-stent. The microorganisms responsible for endotipsitis are most frequently of Gram-negative enteric origin. The regimen and duration of the treatment should be individualized and depends on multiple factors like the antibiotic sensitivity of the organism and the patients condition. In case of a fungal infection, longer treatment is recommended.