BMJ Case Reports 2018; doi:10.1136/bcr-2018-227092
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Tibial osteomyelitis with cold abscess within calf muscles in a toddler referred with suspected oligoarthritis to rheumatology clinic

  1. Mahesh Janarthanan2
  1. 1Department of Paediatrics, Sri Ramachandra University, Chennai, India
  2. 2Division of Pediatric Rheumatology, Dept of Pediatrics, Sri Ramachandra University, Chennai, Tamilnadu, India
  1. Correspondence to Dr Mahesh Janarthanan, maheshjanarthanan{at}
  • Accepted 29 August 2018
  • Published 14 September 2018


A 2-year-old male child was referred to the paediatric rheumatology clinic with history of limping, swelling of right knee and low-grade fevers for 6 weeks. About 2 months prior to this presentation, he had an episode of upper respiratory infection which was followed by swelling of the right knee. He was initially treated with oral analgesics by his primary physician. After 6 weeks when there was no improvement, he was referred for evaluation of possible juvenile idiopathic arthritis.

On examination, there was visible swelling of his right knee compared with his left and he was refusing to bear weight on his right lower limb (figure 1). On closer observation, a diffuse swelling was noted over the right calf region with fullness of the popliteal fossa (figure 1). The swelling was not warm or …

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