A 26-year-old man was admitted to our hospital for high fever and throat pain. His pharynx was red and he had a pain on the right side of his neck and a murmur was heard in the same area. Staphylococcus aureus was detected in his blood culture. Contrast-enhanced chest CT revealed multiple nodules and cavities, some of which were with feeding vessels.
He was suspected to have septic pulmonary embolism (SPE), so antibacterial treatment was started. Gallium scintigraphy showed a high accumulation in the upper right side of the neck, which was the region where the murmur was recognized. Angio-CT revealed dilatation of the brachiocephalic artery and right subclavian artery with an arteriovenous fistula (AVF). He had a history of an abnormal murmur on the right side of the neck after an accident in which he was hit by a ball on the right side of his neck when he was in a high school baseball club. We suspected that this blunt trauma caused his AVF. Antibacterial treatment was successful, and he recovered from SPE and was discharged on the 27th day.
The cause of SPE was considered to be a traumatic AVF infection. This is a rare case in which an AVF was probably caused by blunt trauma from being hit by a baseball. The current case report suggested that investigation of the source of the infection is a pivotal issue for SPE.