{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T06:14:11Z","timestamp":1788156851847,"version":"build-2803163510"},"reference-count":8,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Acute cholangitis classically presents with fever, jaundice, and right upper quadrant pain, but atypical or subacute disease may present as pyrexia of unknown origin (PUO) and remain unrecognized until vascular complications develop. We report a 45\u2010year\u2010old man referred for weight loss, malaise, and suspected non\u2010cirrhotic portal hypertension after upper gastrointestinal endoscopy showed esophageal varices despite a normal FibroScan. Detailed history revealed intermittent fever for 2\u2009months. Laboratory evaluation demonstrated marked systemic inflammation, with leukocytosis, neutrophilia, ferritin 1095\u2009ng\/mL, and C\u2010reactive protein &gt;\u2009200\u2009mg\/L, together with a cholestatic\u2010hepatitic liver enzyme pattern and preserved liver synthetic function. Blood and urine cultures were negative. Initial ultrasonography showed bile duct dilatation without a definite obstructing lesion, delaying diagnosis. Subsequent magnetic resonance cholangiopancreatography and contrast\u2010enhanced computed tomography demonstrated biliary abnormality with portal vein thrombosis and periportal collateralization, consistent with septic pylephlebitis, cavernous transformation, and portal biliopathy secondary to occult cholangitis. The patient was treated with intravenous broad\u2010spectrum antibiotics and anticoagulation, with clinical improvement and partial portal vein recanalisation on follow\u2010up ultrasonography at 3\u2009months. This case highlights that occult cholangitis should be considered in patients with PUO and cholestatic liver biochemistry, even in the absence of classic biliary symptoms, and that early cross\u2010sectional biliary imaging may allow timely recognition of pylephlebitis before chronic portal hypertensive and biliary sequelae become established.<\/jats:p>","DOI":"10.1002\/ccr3.73382","type":"journal-article","created":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T07:46:57Z","timestamp":1787384817000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Septic Pylephlebitis and Cavernous Transformation Presenting as Pyrexia of Unknown Origin: A Diagnostic Challenge"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5443-8392","authenticated-orcid":false,"given":"Aditi","family":"Sarker","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Bangabandhu Sheikh Mujib Medical University  Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9300-2950","authenticated-orcid":false,"given":"Prodipta","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Bangabandhu Sheikh Mujib Medical University  Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Razibul","family":"Alam","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Bangabandhu Sheikh Mujib Medical University  Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,22]]},"reference":[{"issue":"2","key":"e_1_2_15_2_1","first-page":"137","article-title":"Fever of Unknown Origin in Adults","volume":"105","author":"David A.","year":"2022","journal-title":"American Family Physician"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.512"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2021-244912"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13030429"},{"issue":"11","key":"e_1_2_15_6_1","article-title":"Septic Portal Vein Thrombosis, Clinical Presentation, and Management","volume":"13","author":"Anand S.","year":"2021","journal-title":"Cureus"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13051517"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.14701\/ahbps.22-029"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-018-5391-y"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.73382","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.73382","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.73382","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:22:23Z","timestamp":1788153743000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.73382"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":8,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/ccr3.73382"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.73382","archive":["Portico"],"relation":{"has-preprint":[{"id-type":"doi","id":"10.22541\/au.177210206.69784674\/v1","asserted-by":"object"}]},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2026-02-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e73382"}}