Case Report: Patient with Acute-On-Chronic Cholecystitis Complicated by Portal Vein Thrombosis Following “Long COVID-19”

Portal vein thrombosis (PVT) is a rare but serious complication of hypercoagulable states or conditions that increase portal pressure, such as liver cirrhosis, inherited or acquired coagulation cascade abnormalities, myeloproliferative disorders, malignancy, inflammation, or infection. COVID-19 has been associated with a prothrombotic state, leading to both arterial and venous thromboses. Here, we present a patient with minimal hypercoagulable risk factors who presented with PVT and acute-on-chronic cholecystitis with bacteremia, likely provoked by residual hypercoagulability from a “long COVID-19” syndrome. An 81-year-old male developed PVT as a complication of acute-on-chronic cholecystitis, with contributing factors potentially including hypercoagulability related to prior COVID-19 infection more than 4 months prior. PVT should remain a diagnostic consideration in patients with various hypercoagulable risk factors, including long COVID-19, who present with relevant clinical findings. There should be a low threshold for the pursuit of further diagnostic imaging, given the serious consequences of delayed diagnosis.