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

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.

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.

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.