Pyomyositis and osteomyelitis: an unusual cause of abdominal pain

Description

A previously healthy 12-year-old boy was referred with a 2-day history of fever and abdominal pain in the right lower quadrant. He had no traumatic episodes. A physical examination indicated tenderness of the right lower quadrant without rebound tenderness and muscular defence. His gait was normal. His white blood cell count was 4.6x10⁹/L and his C reactive protein (CRP) value was 5.9 mg/dL. The findings of abdominal ultrasound examination and enhanced CT were normal and ruled out appendicitis. Mesenteric lymphadenitis was initially diagnosed and empirical therapy with intravenous cefmetazole 100 mg/kg/day was started. On day 3 after admission, his fever abated. However, his blood culture was positive for methicillin-susceptible Staphylococcus aureus (MSSA), and his abdominal pain persisted. Contrast-enhanced MRI revealed hyperintense signals on T2-weighted images in the right internal abdominal oblique muscles (figure 1A) and in the right proximal femur (figure 1B). Inflammation did not involve the...

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