Trauma, Sepsis, and Thrombosis: Extensive Iliofemoral Deep Vein Thrombosis (DVT) Associated With Staphylococcus aureus Septic Thrombophlebitis in an Adolescent.

No clearly defined guidelines exist for the management of septic thrombophlebitis in the pediatric population despite its life-threatening complications. Management mainly consists of a combination of early antimicrobial therapy, anticoagulation, and source control. In this report, we present the case of a 13-year-old male who presented with a two-week history of right thigh pain and swelling, fever, chest pain, and a productive cough following trauma sustained during a football game. Doppler USG revealed extensive, near-total occlusion of the popliteal and iliofemoral veins, and blood cultures isolated Staphylococcus aureus. The patient was also diagnosed with pneumonia and subsequently developed septic arthritis of the right knee requiring arthrotomy and washout. Laboratory investigations were significant for leukocytosis, severe thrombocytopenia, and hepatic dysfunction consistent with sepsis. There was complete resolution of all thrombi following a prolonged course of IV antibiotics and anticoagulation, administered for 36 and 25 days, respectively. This case highlights the complex interaction between trauma, sepsis, and thrombosis. It reinforces the need to reconsider infection as a primary driver of thrombogenesis rather than a secondary complication while highlighting the associated diagnostic and therapeutic challenges.