TY - JOUR T1 - Pyomyositis and osteomyelitis: an unusual cause of abdominal pain JF - BMJ Case Reports DO - 10.1136/bcr-2017-223871 VL - 2018 SP - bcr-2017-223871 AU - Michimasa Fujiwara AU - Yoshiko Abe AU - Aya Kodera AU - Tooru Araki Y1 - 2018/03/20 UR - http://casereports.bmj.com/content/2018/bcr-2017-223871.abstract N2 - 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 … ER -