A previously healthy and correctly vaccinated child aged two years and six months, with the exception of chickenpox.
She had scarlet fever six days before the rash appeared.
On the fifth day, a high fever persists and there is edema in the left foot and ankle.
She was diagnosed with ankle arthritis and treated as outpatients with oral amoxicillin-clavulanic acid 80 mg/kg/day (amoxicillin).
The swelling increased 48 hours later, so we decided to admit the patient.
The physical examination showed good general condition, with multiple varicella lesions predominantly pustulous, pain, swelling, significant edema in the left foot and ankle and erythematous plaque in the foot sole.
He does not walk independently.
The rest of the physical examination is normal.
Analytical control showed 13 600 leukocytes/mm3, neutrophils; hemoglobin 10.7 g/dl; hematocrit 31.1%; platelets 374,000/mm3, and erythrocyte sedimentation rate 116 (GSR).
Blood culture was negative.
It is treated with intravenous amoxicillin/clavulanate (IV), but the swelling worsens on the fourth day.
An X-ray of the lower limb showed an increase in soft tissues, and an ultrasound showed an internal twin muscle with hypoxicity and tumefaction with loss of edema pattern and dyscoxia of reflected tissue.
There is no evidence of abscess susceptible to drainage.
Antibiotic treatment with cefoxime and cloxacillin was established, but since the clinical, analytical and ultrasound course was unfavorable, it was decided to change the regimen by clindamycin and IV vancomycin with subsequent decrease in VSG.
Upon discharge she was able to walk independently and had no functional sequelae.
