ConditionInfections
Septic Thrombophlebitis
Septic thrombophlebitis is a blood clot in a vein that has become infected, combining inflammation of the vein, a clot and bacteria. It can occur in a superficial arm vein after an IV catheter, in the jugular vein after a throat infection (Lemierre syndrome), in the pelvic veins after childbirth or pelvic surgery, or in veins near the brain or liver. It causes fever that persists despite antibiotics, and can seed infection to the lungs and elsewhere. Treatment combines prolonged antibiotics, removing infected lines or veins, and sometimes blood thinners.
Also called: Suppurative thrombophlebitis, infected thrombophlebitis, infected vein thrombosis, Lemierre syndrome (jugular type), septic pelvic thrombophlebitis
At a glance
- What it is
- An infected clot inside a vein, often with pus in the vessel.
- Types
- Superficial (IV catheter sites, injection drug use), jugular (Lemierre syndrome), pelvic (after childbirth or surgery), intracranial and portal vein.
- Symptoms
- Fever, chills, a red, tender, hard vein, swelling; persistent fever despite antibiotics.
- Complications
- Bloodstream infection, septic emboli to the lungs, endocarditis, sepsis.
- Diagnosis
- Blood cultures, ultrasound or CT of the vein.
- Treatment
- Remove the IV line or infected vein, weeks of IV antibiotics, sometimes anticoagulation or surgery.
When to get help
Call 911 or go to the ER
- Fever with rapid breathing, confusion, low blood pressure or cold, mottled skin (possible sepsis)
- Severe sore throat followed days later by neck swelling, high fever and chest pain or breathlessness (possible Lemierre syndrome)
- Fever with severe headache, eye swelling or bulging eye, or double vision (possible cavernous sinus thrombosis)
See a doctor within a day or two
- A red, hot, hard, painful vein at a current or recent IV site, especially with fever or pus
- Fever that persists despite antibiotics after childbirth, cesarean or pelvic surgery
- Swelling of an arm or neck with fever in someone with a central line or who injects drugs
Book a routine appointment
- A tender, cord-like vein without fever, for assessment and monitoring
What happens in septic thrombophlebitis
Thrombophlebitis is inflammation of a vein with a clot. When bacteria colonize the clot, often from an IV catheter, nearby infection or bloodstream infection, the clot becomes a protected reservoir where antibiotics struggle to reach. Bacteria continue to shed into the blood, and pieces of infected clot (septic emboli) can travel to the lungs and other organs.
Types
| Type | Typical setting | Key features |
|---|---|---|
| Superficial (peripheral) | IV catheters, injection drug use, burns | Red, tender, hard vein; pus at the site; fever |
| Central venous catheter-related | Long-term central lines, dialysis catheters | Fever, arm or neck swelling, bloodstream infection |
| Lemierre syndrome (internal jugular vein) | Teenagers and young adults after a throat infection | Sore throat, then neck pain and swelling, high fever, lung emboli; usually Fusobacterium necrophorum |
| Septic pelvic thrombophlebitis | After childbirth, cesarean, abortion or pelvic surgery | Fever that persists despite antibiotics, sometimes pelvic pain |
| Intracranial (cavernous sinus thrombosis) | After facial, sinus or dental infections | Headache, eye swelling, eye movement problems |
| Portal vein (pylephlebitis) | After appendicitis or diverticulitis | Fever, abdominal pain, liver abscesses |
Symptoms
- fever and chills, often high and persistent
- pain, redness, warmth and swelling along a vein
- a firm, cord-like vein that can be felt
- pus at an IV site
- swelling of the limb or neck, which can resemble a deep vein thrombosis
- symptoms of spread: cough, chest pain and breathlessness from lung emboli, joint pain, heart murmur
Risk factors
- IV catheters, especially those left in place for several days or placed in an emergency
- central venous lines and hemodialysis catheters (see catheter thrombosis)
- injection drug use
- recent throat infection (Lemierre syndrome)
- childbirth, especially cesarean delivery, and pelvic surgery
- burns and weakened immune systems
Diagnosis
- blood cultures, often repeatedly positive
- ultrasound of the affected vein (arm, leg, neck)
- CT or MRI with contrast for jugular, pelvic, portal or intracranial veins
- chest CT for septic emboli
- echocardiogram to rule out endocarditis in persistent bloodstream infection
- culture of pus or the removed catheter tip
Treatment
- remove the source: take out the IV or central line; drain any abscess
- IV antibiotics: broad-spectrum at first, then targeted to the organism, usually for several weeks
- surgery: excision of an infected superficial vein when infection persists despite antibiotics and line removal
- anticoagulation: used in some types, such as septic pelvic thrombophlebitis and some cases of Lemierre syndrome or central vein thrombosis; decisions are individualized
- supportive care for sepsis
Prevention
- remove IV lines as soon as they are not needed
- daily inspection of IV sites; report pain, redness or swelling
- sterile technique when placing and caring for lines
- harm reduction services for people who inject drugs
- prompt treatment of throat, dental and pelvic infections
Frequently asked questions
What is septic thrombophlebitis?
Septic thrombophlebitis is an infected blood clot in a vein. It most commonly occurs at IV catheter sites, in the jugular vein after a throat infection, or in pelvic veins after childbirth or surgery. It causes fever and can spread infection through the bloodstream.
What is Lemierre syndrome?
Lemierre syndrome is septic thrombophlebitis of the internal jugular vein in the neck, usually following a sore throat in teenagers or young adults. It is typically caused by Fusobacterium necrophorum and can send infected clots to the lungs. It needs urgent hospital treatment.
How is septic thrombophlebitis treated?
Treatment includes removing any infected IV line, several weeks of IV antibiotics, draining abscesses and sometimes removing the infected vein. Blood thinners are used in some types, such as pelvic septic thrombophlebitis.
How is it different from regular thrombophlebitis?
Regular superficial thrombophlebitis is an inflamed, clotted vein without infection, usually managed with warm compresses and anti-inflammatory medicine. Septic thrombophlebitis is infected, causes fever and needs antibiotics and often line or vein removal.
Sources
This guide was written from current patient and clinical guidance, including:
- Infectious Diseases Society of America: Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection (2009)
- CDC: Guidelines for the Prevention of Intravascular Catheter-Related Infections
- American College of Obstetricians and Gynecologists: postpartum infection guidance
- MedlinePlus: Thrombophlebitis
- StatPearls (NCBI Bookshelf): Septic Thrombophlebitis; Lemierre Syndrome