An 8-year-old male patient presented with a nasal forum and arthritis in the posterior aspect of the left thigh for one week.
She came to the emergency department with a diagnosis of colitis and started treatment with trimethoprim-methoprim-methotoxazole (TMP-SMX) at 10 mg/kg/day orally administered TMP.
She presented with pain in the anterior region of the contralateral thigh and referred to a sports traumatism in that area.
A soft tissue ultrasound is performed, which shows "image of tubular particulate content parallel to muscle fibers in the middle third of the crural muscle"; it is interpreted as intramuscular hematoma and it is indicated to continue with the same therapeutic scheme.
On the fifth day of treatment, due to functional impotence of the right lower limb, worsening of the facial lesion and starting with febrile records, the patient was hospitalized.
Upon admission, the patient is in regular general condition, feverish and presents an indurated, erythematous, painful lesion on the right cheek extended to the wing of the nose, associated with edema in the upper lip.
In addition, a painful tumor to deep fixation in the anterior aspect of the right thigh with poorly defined limits was found.
Leukocytosis with neutrophilia (GB: 12 200/mm3, NS: 78%, NC: 2%) and increased acute phase reactants (ESD: 100 mm/h and CRP: 79.41 mg/L); LDH/L
Computed tomography (CT) of the thighs was performed with intravenous contrast (EV), which showed left semitendinosus contrast images compatible with the thickness of the vastus medialis muscle of 3.6 x 2.6 x 0.6 cm and, cm administration of the thigh
Upon admission, two blood cultures were taken with negative results; percutaneous drainage of the lesions of both thighs was performed and purulent material was obtained with rescue of methicillin-resistant Staphylococcus aureus (MRSA).
The lesion present in the right thigh evolves favorably.
On the contrary, due to pain and induration in the posterior aspect of the left thigh, open surgical drainage of the collection was performed on the third day of hospitalization.
In the culture of purulent material, the development of MRSA with the same sensitivity profile is obtained.
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The patient received 7 days of treatment with clindamycin at 40 mg/kg/day EV and 5 days of TMP-SMX at 10 mg/kg/day EV, with favorable evolution.
After twelve days of hospitalization, laboratory parameters were verified: GB 9300/mm3 (NC: 2%, NS: 46%), CRP: 16 mg/L. Affected zones showed improvement in the walking ability.
Hospitalization was granted; outpatient follow-up continued and she was treated with oral TMP-SMX for 21 days, with resolution of her clinical condition.
