Serial Polymicrobial Wound Infection Including Multidrug-Resistant Acinetobacter baumannii in a Patient with Budd-Chiari Syndrome: A Case Report

Budd-Chiari syndrome is an uncommon disorder of hepatic venous outflow obstruction that leads to portal hypertension, ascites, hypoalbuminaemia and impaired tissue repair. Such patients are predisposed to chronic, poorly healing wounds and to recurrent infection. We report a 40-year-old woman with established Budd-Chiari syndrome and intrahepatic inferior vena caval obstruction, previously treated with balloon angioplasty and maintained on oral anticoagulation, who presented with a recurrent, non-healing right lower limb ulcer and cellulitis. Over a five-week admission, serial wound cultures yielded three different gram-negative organisms in sequence: Klebsiella pneumoniae, multidrug-resistant Acinetobacter baumannii, and Enterobacter cloacae. Antimicrobial therapy was adjusted at each step according to susceptibility, comprising empirical piperacillin-tazobactam and ciprofloxacin, followed by meropenem, tigecycline and oral minocycline. Care also addressed the systemic contributors to poor healing through albumin infusion, correction of anaemia, diuresis, therapeutic ascitic tapping and nutritional support. The ulcer showed healthy granulation with minimal discharge at discharge, although complete epithelialisation was not documented. This case illustrates the potential value of repeated culture, susceptibility-guided antimicrobial adjustment and coordinated multidisciplinary care in the recurrent, polymicrobial wound infections that complicate chronic liver disease.