Staphylococcus aureus–associated pyomyositis complicated by deep vein thrombosis and septic pulmonary embolism in a malnourished child: a case report
- 1Department of Pediatrics and Child Health, Arsi University College of Health Sciences, Asella, Ethiopia
- 2Department of Radiology, College of Health Sciences, Arsi University, Asella, Ethiopia
- 3Department of Surgery, College of Health Sciences, Arsi University, Asella, Ethiopia
Abstract
Background: Septic pulmonary embolism (SPE) is a rare, life-threatening complication of venous thromboembolism in children, occurring when an infected thrombus from an extrapulmonary focus embolizes to the pulmonary circulation. The co-occurrence of acute musculoskeletal infection, deep venous thrombosis (DVT), and SPE is an exceedingly rare pediatric triad, most commonly caused by Staphylococcus aureus. We report this triad from a resource-limited Ethiopian hospital to highlight diagnostic and management challenges relevant to similar sub-Saharan African settings.
Case presentation: A 12-year-old Oromo boy presented with four days of progressive left thigh swelling, pain, and high-grade fever, one week after a minor fall while playing football with no associated skin disruption. He had moderate acute malnutrition (BMI 14.4 kg/m²). Imaging confirmed pyomyositis, and incision and drainage yielded approximately 200 mL of purulent material. On post-operative day 3, he developed tachypnea and pleuritic chest pain; Doppler ultrasound showed proximal DVT of the left lower limb, and chest CT showed multiple peripheral cavitary nodules with the feeding-vessel sign, consistent with septic pulmonary embolism. Blood culture grew Staphylococcus aureus sensitive to vancomycin and meropenem. He was treated with intravenous vancomycin and meropenem, anticoagulation with unfractionated heparin transitioning to warfarin, and nutritional rehabilitation, achieving complete clinical and radiological recovery after six weeks of antibiotics and three months of anticoagulation.
Conclusions: This triad in a malnourished child highlights the need for a high index of suspicion for septic embolization arising from deep soft-tissue infection, particularly in resource-limited settings where laboratory and diagnostic capacity are constrained. Early recognition, aggressive source control, targeted antimicrobial therapy, and appropriate anticoagulation can achieve favorable outcomes.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12887-026-07450-w.
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BibTeX
@article{gebremeskel2026staphylococcus,
title = {{Staphylococcus aureus–associated pyomyositis complicated by deep vein thrombosis and septic pulmonary embolism in a malnourished child: a case report}},
author = {Tesfa Gebremeskel and Nuri Mama and Mesfin Wubishet and Samuel Gashu},
journal = {BMC Pediatrics},
year = {2026},
month = jul,
doi = {10.1186/s12887-026-07450-w},
url = {https://doi.org/10.1186/s12887-026-07450-w},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Staphylococcus aureus–associated pyomyositis complicated by deep vein thrombosis and septic pulmonary embolism in a malnourished child: a case report
AU - Tesfa Gebremeskel
AU - Nuri Mama
AU - Mesfin Wubishet
AU - Samuel Gashu
PY - 2026
DA - 2026/07/01
JO - BMC Pediatrics
DO - 10.1186/s12887-026-07450-w
UR - https://doi.org/10.1186/s12887-026-07450-w
AB - Background: Septic pulmonary embolism (SPE) is a rare, life-threatening complication of venous thromboembolism in children, occurring when an infected thrombus from an extrapulmonary focus embolizes to the pulmonary circulation. The co-occurrence of acute musculoskeletal infection, deep venous thrombosis (DVT), and SPE is an exceedingly rare pediatric triad, most commonly caused by Staphylococcus aureus. We report this triad from a resource-limited Ethiopian hospital to highlight diagnostic and management challenges relevant to similar sub-Saharan African settings. Case presentation: A 12-year-old Oromo boy presented with four days of progressive left thigh swelling, pain, and high-grade fever, one week after a minor fall while playing football with no associated skin disruption. He had moderate acute malnutrition (BMI 14.4 kg/m²). Imaging confirmed pyomyositis, and incision and drainage yielded approximately 200 mL of purulent material. On post-operative day 3, he developed tachypnea and pleuritic chest pain; Doppler ultrasound showed proximal DVT of the left lower limb, and chest CT showed multiple peripheral cavitary nodules with the feeding-vessel sign, consistent with septic pulmonary embolism. Blood culture grew Staphylococcus aureus sensitive to vancomycin and meropenem. He was treated with intravenous vancomycin and meropenem, anticoagulation with unfractionated heparin transitioning to warfarin, and nutritional rehabilitation, achieving complete clinical and radiological recovery after six weeks of antibiotics and three months of anticoagulation. Conclusions: This triad in a malnourished child highlights the need for a high index of suspicion for septic embolization arising from deep soft-tissue infection, particularly in resource-limited settings where laboratory and diagnostic capacity are constrained. Early recognition, aggressive source control, targeted antimicrobial therapy, and appropriate anticoagulation can achieve favorable outcomes. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12887-026-07450-w.
SN - 1471-2431
ER -