Uncommon manifestation of MRSA-related deep vein thrombosis and lung abscesses in a young child: a case report.

INTRODUCTION AND

IMPORTANCE

Cellulitis, a common skin and soft tissue infection, can lead to complications such as deep vein thrombosis (DVT), presenting with unilateral limb swelling, erythema, and pain. Methicillin-resistant Staphylococcus aureus (MRSA) is a notable causative pathogen for severe cases and complications.

CASE PRESENTATION: We report a rare case of MRSA-induced DVT and lung abscesses in a 5-year-old male following a knee injury. The child initially presented with fever, vomiting, abdominal pain, and restricted movement in the right leg. Laboratory tests confirmed DVT, and chest imaging subsequently revealed multiple lung abscesses. Septic arthritis was ruled out based on a knee synovial fluid test showing no growth of pathogenic bacteria. The patient received initial treatment with intravenous (IV) fluids, subcutaneous enoxaparin sodium (clexane), and IV antibiotics (teicoplanin and ceftazidime). Treatment was later modified to include vancomycin, metronidazole, and finally, linezolid due to its superior lung penetration and clinical response. Endocarditis was ruled out via transthoracic echocardiography. The patient showed marked improvement and was successfully discharged after 2 months.

CLINICAL DISCUSSION: This case underscores the importance of considering DVT as a potential complication of cellulitis in pediatric patients, particularly with MRSA involvement. The pathophysiology of MRSA-induced DVT involves bacterial toxins that promote platelet aggregation, thrombin activation, and endothelial dysfunction, creating a procoagulant milieu. This case adds to the limited literature on pediatric MRSA infections leading to such severe complications and emphasizes the need for early recognition and targeted therapy.

CONCLUSION

MRSA-related infections can lead to rare but severe complications in pediatric patients. Clinicians should maintain a high index of suspicion for DVT and lung abscesses in cases of MRSA cellulitis, particularly following trauma. Early diagnosis and aggressive treatment are essential for better outcomes.