A Multifactorial Presentation of Infection and Thrombosis: Temporal Clustering of Pneumonia, Hepatic Abscess, Bilateral Deep Vein Thromboses (DVTs), and Appendicitis in a Child

Multisystem infectious and thrombotic presentations are rare in pediatric patients and often raise concern for an underlying immunologic or hematologic disorder. We report a case of a 13-year-old male with sickle cell trait and beta-thalassemia trait heterozygote who developed extensive bilateral deep vein thromboses (DVTs), a large hepatic abscess, right-sided pneumonia with empyema, and subsequently perforated appendicitis with intra-abdominal abscesses. The patient required broad-spectrum antimicrobial therapy, anticoagulation, percutaneous abscess drainage, and emergent surgical intervention. An extensive evaluation excluded inherited thrombophilias, autoimmune disease, and chronic granulomatous disease. The close temporal clustering of these events highlights a multifactorial process involving systemic inflammation, infection, and acquired hypercoagulability. This case underscores the importance of multidisciplinary management and longitudinal follow-up in pediatric patients presenting with recurrent or multifocal infections and thrombosis.