Abstract
A 61-year-old man was admitted to an outside medical facility with left leg deep vein thrombosis and bilateral pulmonary emboli. His clinical course was complicated by hypotension, azotemia and declining mental status. Positive blood cultures for gram-positive cocci prompted transfer to our institution. Despite broad-spectrum antibiotics (vancomycin, cefepime, and ciprofloxacin), the patient remained febrile (temperature 39.4°C) with persistent leukocytosis. An echocardiogram revealed no valvular vegetations. Bacteremia persisted with methicillin-sensitive Staphylococcus aureus despite antimicrobial therapy. In the absence of a clear source of infection, an indium-111labeled white blood cell (WBC) scan was performed, revealing radiotracer enhancement of the left popliteal, femoral, and common femoral veins (Panels A and B) corresponding to thrombus location as assessed by ultrasound (Panels C and D). Radiotracer uptake within these Images in Vascular Medicine
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