Upper-Extremity Deep Venous Thrombosis Associated with Proximal Humeral Osteomyelitis in a Child

Deep venous thrombosis and septic pulmonary embolism are known to occur in association with pediatric musculoskeletal infections. The authors of recent studies have reported an apparent increase in the incidence of this phenomenon, which appears to be related to the rising occurrence of infections caused by methicillin-resistant Staphylococcus aureus 1. Some authors have suggested that the Panton-Valentine leukocidin gene, which may be expressed by methicillin-resistant Staphylococcus aureus , is responsible for severe consequences of infection including necrotizing pneumonia, deep venous thrombosis, septic pulmonary embolism, and an enhanced local inflammatory response leading to abscess formation in tissues adjacent to the site of infection2-5. We previously reported on thirteen children with deep venous thrombosis that occurred in association with osteomyelitis (eleven), septic arthritis (one), or pyomyositis (one), and we identified characteristics of these children that may help to guide clinicians in assessing the relative propensity of a child with musculoskeletal infection to develop deep venous thrombosis6. In that report, 25% of the children above the age of eight years who had osteomyelitis caused by methicillin-resistant Staphylococcus aureus and who presented with a C-reactive protein level of >6 mg/dL were noted to have deep venous thrombosis, but none of the children with deep venous thrombosis in that report had an upper-extremity infection. The majority of the infections occurred adjacent to the knee, involving either the proximal part of the tibia or the distal part of the femur, with the deep venous thrombosis located in the popliteal or femoral vein. We present here the case of a child with acute osteomyelitis of the humerus associated with a deep venous thrombosis in the ipsilateral upper extremity and septic pulmonary embolism. The parents of the patient were informed that data concerning the case would be submitted for publication, and …