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