Neonatal presumed septic pulmonary embolism associated with a peripherally inserted central catheter: a case report

Septic pulmonary embolism (SPE) is a rare complication of peripherally inserted central catheters (PICC), with few neonatal reports. We present a premature infant who developed recurrent apnea and hypoxemia during PICC indwelling. Imaging revealed bilateral thick-walled cavitary lesions. Although two consecutive conventional peripheral blood cultures remained negative, MSSA was identified from PICC tip culture, deep sputum culture, and NGS analysis of peripheral blood, PICC intraluminal blood, and deep sputum samples. The infant recovered after 39 days of antimicrobial therapy, including five weeks of targeted linezolid. This case suggests that PICC surface biofilms were the most probable source of septic emboli causing occult SPE, underscoring the importance of considering catheter-related pulmonary embolism in neonates with unexplained respiratory deterioration.