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Pyomyositis and osteomyelitis: an unusual cause of abdominal pain
  1. Michimasa Fujiwara,
  2. Yoshiko Abe,
  3. Aya Kodera,
  4. Tooru Araki
  1. Department of Pediatrics, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
  1. Correspondence to Dr Michimasa Fujiwara, miclegend2020{at}yahoo.co.jp

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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 4.6×109/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 …

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