Uncommon Complications of Osteomyelitis: Deep Vein Thrombosis and Pulmonary Septic Emboli in Two Healthy Pediatric Patients: A Case Report and Literature Review.

Abstract

Acute osteomyelitis in children is typically a localized hematogenous infection; however, its presentation with deep vein thrombosis (DVT) and septic pulmonary emboli (SPE) is exceptionally rare. Fewer than fifteen similar cases have been reported in the literature. We describe two previously healthy pediatric patients who developed multifocal osteomyelitis, DVT, and SPE in the setting of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Both children initially presented with nonspecific limb pain, fever, and markedly elevated inflammatory markers, with early imaging proving nondiagnostic. Each subsequently developed venous thrombosis and septic emboli prior to confirmation of osteomyelitis, reflecting an aggressive clinical pattern. MRI later revealed multifocal bone involvement with subperiosteal abscesses requiring surgical drainage. Management required prolonged targeted intravenous antibiotics, anticoagulation, and coordinated multidisciplinary care. These cases highlight the importance of early suspicion for musculoskeletal infection in febrile children with persistent limb pain and systemic MRSA infection. Early MRI and prompt recognition of thromboembolic complications are essential for improving outcomes.