Methicillin-resistant Staphylococcus aureus infection can cause serious illness in children. It can progress to life-threatening bloodstream issues or bone infections, including: deep vein thrombosis, septic pulmonary embolism, toxic shock syndrome, and osteomyelitis. Treatment depends on control of infection with adequate antibiotics and early anticoagulation. We present a case of a 11-year old male child who presented with left arm and right leg pain and swelling that was associated with fever. However, there was no history of trauma. Blood culture was taken and showed Methicillin-resistant Staphylococcus aureus growth. Initial ultrasound of the affected limbs was unremarkable except for subcutaneous edema. On the following day, ultrasound of the affected limbs was consistent with deep vein thrombosis. Additionally, the patient developed pleuritic chest pain and a computed tomography scan with pulmonary angiography demonstrated a filling defect in the left upper segmental artery suggesting septic pulmonary embolism. Magnetic resonance imaging of the lower limbs was recommended and it suggested the diagnosis of osteomyelitis. Ultrasound guided drainage was done and the patient was treated with appropriate antibiotics and enoxaprine. Multifocal thromboembolic events with osteomyelitis in an immunocompetent child are rare and clinically important. This case highlights the complex nature of methicillin-resistant Staphylococcus aureus infection in pediatrics and emphasizes the value of early imaging and multidisciplinary collaboration to establish an accurate diagnosis and a good clinical outcome. Awareness of such presentations can facilitate earlier diagnosis and intervention, to reduce the risk of complications in pediatric patients.
Khatib et al. (2026) studied this question.