Complicating staphylococcal osteomyelitis is venous thrombosis

July 1, 2006

Although infrequently reported, Staphylococcus aureus infections, especially osteomyelitis, have been associated with venous thrombosis (VT) and pulmonary emboli in children. Noting that the number of VTs has increased greatly at Texas Children's Hospital in Houston in patients with S aureus infection, investigators set out to describe clinical and molecular features of such infections at that institution.

The team reviewed records and imaging studies (chest radiographs, sonograms, computed tomographic scans, and magnetic resonance imaging scans) of nine patients who received a diagnosis of acute S aureus osteomyelitis and new-onset VT during a five-and-a-half year period. All patients were male; mean age was 10.6 years. Seven had an infection caused by methicillin-resistant S aureus (MRSA), all considered community-acquired; two had an infection caused by community-acquired methicillin-susceptible S aureus.

Most often, the femoral veins were thrombosed, with clots frequently extending into the popliteal veins. All nine patients had osteomyelitis and pyomyositis adjacent to the site of thrombosis. Pulmonary imaging revealed evidence of septic emboli in four patients, three of whom had multiple nodular lesions that were evident on initial chest radiographs. Six had no family history of VT or conditions that would predispose them to thrombi.

Commentary S aureus keeps changing-an argument for evolution. Keep venous thrombosis in mind when you care for children with community-acquired MRSA, especially with osteomyelitis. (And I wonder why all the patients were boys....)