This is a 7-year-old boy, with no relevant personal pathological history, who begins with a febrile syndrome without detectable focus.
72 hours after the onset of the clinical picture, the child complained of pain and functional impotence in the right shoulder, without signs of phlogosis on physical examination.
In the initial evaluation a simple radiography and ultrasound of the affected shoulder were requested, both studies with normal results.
After presenting high and persistent fever for 6 days, the physical examination revealed erythema and edema in the right clavicular region, which led to the decision to admit the patient.
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Initial laboratory tests revealed leukocytosis (GB: 19.890/mm3) with neutrophilia (PC-R: 90) and elevated erythrocyte sedimentation rate (ERS: 57 mm).
CPK values were normal (50 UI/L).
When a deep focus of infection is suspected, magnetic resonance imaging (MRI) is requested, which shows intense myoedema that compromises the right pectoralis major muscles.
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Two hemocultives were performed and treatment with parenteral cephalothin was initiated.
After 48 h of treatment initiation, the child remains febrile, and presents increased erythema and edema in the affected area.
The results of the hemocultives taken at admission are received, which are positive for SAMRC (resistant to clindamycin); the therapeutic scheme is modified and vancomycin is indicated intravenously and rifampicin is indicated.
Two days later, the fever begins to decrease and the lesion becomes circumscribed and fluctuating.
There is also an erythematous cutaneous exanthema with scaling that predominates in the trunk and axilla.
Nasal, axillary and anal swabs were performed and the germ previously isolated from the nasal mucosa was obtained.
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A second MRI showed a higher hierarchy of edema in the right pectoralis major muscle tissue extending the process to the minor pectoral, subclavian, bloid and adjacent muscles.
Formation of a fluid collection around the proximal third of the right clavicle.
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The abscess was drained by puncture and a scintigraphy was requested to rule out bone involvement.
The child progresses favorably and completes ten days of treatment with parenteral vancomycin, and then twenty days with oral trimetoxasol.
