Persistent type IV hypersensitivity after cyanoacrylate closure of the great saphenous vein.

The VenaSeal (Medtronic, Minneapolis, Minn) cyanoacrylate closure system is a nonthermal technique for ablating saphenous veins using a proprietary n-butyl cyanoacrylate. One possible side effect is an allergic reaction to cyanoacrylate. We report the case of a 49-year-old woman treated with cyanoacrylate closure who developed a persistent type IV hypersensitivity reaction. The patient elected to have the vein excised, and the histologic features were consistent with a type IV hypersensitivity reaction.

Pylephlebitis: keep it in your differential diagnosis.

Pylephlebitis is thrombophlebitis of the portal vein or its tributaries. It is a rare diagnosis that carries a high mortality if not diagnosed and treated before the onset of sepsis. The authors describe a case of pylephlebitis in a patient who represented with sepsis after surgical treatment of perforated appendicitis.