Description
An 8-year-old boy presented with painful swelling at the distal left arm for 2 weeks and intermittent fever. He had no history of trauma, inoculation or insect bite. On examination, his temperature was 38.6 °C. There was a 4x4 cm ill-defined swelling at the medial aspect of distal left arm, just above the elbow joint. It was erythematous, tender, firm and warm with restricted mobility. Pain was aggravated on moving the left elbow. There was no enlarged regional node, skin lesion or puncture wound. He was suspected to have subcutaneous abscess and was treated empirically with intravenous cloxacillin. Unfortunately he developed allergic reaction, and the antibiotic was changed to intravenous cefuroxime.
Total white count (TWC, 15x109/L) and erythrocyte sedimentation rate (ESR, 69 mm/hour) were raised. Plain radiographs showed soft tissue swelling with normal underlying humerus. Ultrasound revealed a well-defined, lobulated, hypoechoic lesion measuring 17.6x21.1x22.4 mm just deep to the basilic vein....
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