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Septic Superficial Femoral Vein Thrombophlebitis Causing Pulmonary Emboli and Respiratory Failure: Case Report and Review of the Literature

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International Journal of Clinical Medicine 2019年第8期10卷 413-420页

作者： ziad fayad Paul Guentert Erin Rissler Nuha Zackariya Shivani Patel Ali Sualeh Mahmoud Al-Fadhl Sufyan Zackariya Grant Wiarda Mallory Martin Joseph Lake Sarah Philbrick Mark Walsh General and Vascular Surgery X-Ray Consultants South Bend IN USA Saint Joseph Regional Medical Center Mishawaka IN USA St. Luc Family Hospital Tabarre Haiti Indiana University School of Medicine South Bend Campus South Bend IN USA

Septic pulmonary emboli rarely cause respiratory failure that requires mechanical ventilation. The most common causes of septic pulmonary emboli are related to intravenous drug abuse, indwelling intravenous catheters, endocarditis and septic pelvic thrombophlebitis. In addition, soft tissue injury-related thrombophlebitis rarely causes septic pulmonary emboli. We describe a unique case of a 43-year-old man who developed septic thrombophlebitis of the femoral vein following soft tissue injury from trauma to the shin with ensuing septic pulmonary emboli which necessitated endotracheal intubation and mechanical ventilation. The patient required mechanical ventilation for eleven days, developed empyema and grew out methicillin-resistant Staphylococcus aureus on blood cultures. A transesophageal echocardiogram was normal, and there was no indication of bacterial endocarditis. In addition to eleven days of mechanical ventilation, the patient was treated with intravenous heparin, cefepime and clindamycin. These medications were then discontinued and the patient was treated with weight-adjusted vancomycin. Following the return of cultures, the patient was treated for six weeks with ceftaroline 600 mg IV twice a day. In addition, the patient received bilateral thoracentesis followed by chest tube drainage until resolution of the pleural effusions. The patient made a complete recovery. We describe this case and the implications for differential diagnosis and treatment of these two uncommon conditions.

关键词： Septic Thrombophlebitis Pulmonary Emboli Respiratory Failure Critical Care

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