A Rare Triad of Osteomyelitis, Thrombophlebitis and Septic Pulmonary Embolism caused by Enterococcus in an Adolescent: A Case Report

Acute febrile illnesses in Indian subcontinent commonly occur in monsoon season and presents with fever, bodyache, rash, headache, myalgia and sometimes with complications like acute respiratory distress, renal failure, bleeding tendencies. Herein, authors report an unusual case of 13-year-old boy presenting with fever and respiratory distress preceded by history of trivial trauma to his left arm. On subsequent investigations, including Magnetic Resonance Imaging (MRI) of left arm, CT-Pulmonary Angiography (CTPA), High Resolution Computed Tomography (HRCT) thorax and blood culture, he was found to have Septic Pulmonary Embolism (SPE) secondary to acute osteomyelitis induced deep vein thrombophlebitis. Blood culture grew Enterococcus species which is a rare finding. Patient required invasive ventilation, anticoagulant and higher antibiotics for six weeks, following which his condition gradually improved and did not require surgical intervention. A trivial trauma to left arm resulting into enterococcal acute osteomyelitis leading to deep vein thrombophlebitis and SPE. The triad of acute osteomyelitis, deep vein thrombophlebitis and SPE may lead to life threatening complications, if not diagnosed early.