Recurrent Klebsiella pneumoniae Bacteremia Due to Endotipsitis.

Transjugular intrahepatic portosystemic shunt (TIPS) procedures are commonly performed in patients with cirrhosis to decrease the pressure in the portal system. An unusual complication of this procedure is endotipsitis, an infection of the shunt/stent with resultant sustained bacteremia caused by vegetation within the TIPS. The most commonly associated pathogens include staphylococci, enterococci, streptococci, and enteric Gram-negative bacilli. We present a patient who developed endotipsitis due to and presented with refractory bacteremia. Our patient had a progressively worsening clinical picture and after recognition of endotipsitis was transferred to another facility for liver transplantation and removal of the TIPS. Rapid diagnosis of endotipsitis in the setting of refractory bacteremia is essential to patient survival.