Septic Pulmonary Embolism in Pediatric Population: A Case Series With Literature Review

Abstract

Background: Septic pulmonary embolism (SPE), resulting from infections such as osteomyelitis and endocarditis, is rare and lacks specific diagnostic guidelines. This report reviews the clinical manifestations, radiographic abnormalities and antibiotic therapy in children with SPE.

Methods: Patients 1 to 18 years of age with confirmed SPE were identified from a database using the International Classification of Diseases-9/10 codes from 2000 to 2020. After excluding duplicates and those with neoplastic disease, 8 patients were included of 16 encounters.

Results: Patients predominantly presented with shortness of breath, fever and chest pain. Half had identifiable extrapulmonary infection sources. Leukocytosis was present in 50% and leukopenia in 12.5%. Anemia was noted in 87.5% of patients, possibly linked to patients' acute illness. Contrasted chest computed tomography showed bilateral emboli in most patients. Echocardiograms were normal. Methicillin-resistant Staphylococcus aureus was identified in 62.5% of cases and oxacillin-sensitive staphylococcus aureus in 37.5%. While osteomyelitis was the most common infection source, our series uniquely included cavernous sinus thrombosis in children and reported for the first time. Most patients were empirically treated with vancomycin.

Conclusion: This case series highlights cavernous sinus thrombosis as a new clinical entity associated with pediatric SPE. It emphasizes the significance of prompt, targeted antibiotic therapy for improved outcomes in children with SPE.

Keywords: cavernous sinus thrombosis; computed tomography pulmonary angiogram; methicillin-resistant staphylococcus aureus; oxacillin-sensitive staphylococcus aureus; pediatric emergency medicine; septic pulmonary embolism.