Clinical case report: discitis osteomyelitis complicated by inferior vena cava venous thrombosis and septic pulmonary emboli

Viridans group streptococcus is an infrequent cause of osteomyelitis that is found in association with infective endocarditis. Only a few studies report viridans osteomyelitis in the absence of endocarditis. Vertebral pyogenic osteomyelitis can sometimes be complicated by psoas or paraspinal abscesses. These intra-abdominal and/or pelvic collections can very rarely result in venous thrombosis. A paraspinal abscess resulting in inferior vena cava (IVC) thrombosis has only been reported once in the literature. We report a case of a young female with a history of polysubstance abuse and chronic back pain, who was found to have extensive vertebral osteomyelitis and discitis with epidural, paraspinal, and psoas abscesses caused by viridans streptococci. These abscesses compressed on the IVC causing IVC thrombophlebitis extending to the iliac veins distally. Imaging also demonstrated multifocal bilateral septic pulmonary emboli and pleural effusions secondary to septic IVC thrombus; a transesophageal echocardiogram showed no evidence of infective endocarditis.