An 11-year-old male, previously healthy, who consulted in the pediatric emergency department with fever up to 38.5°C axillary for three days, associated with moderate diffuse abdominal pain.
There was no history of trauma or recent travel abroad.
In the general physical examination, only constipation was highlighted.
A rectal enema was given to her giving way to normal stools and was cited for reassessment within 24 h.
The patient remained febrile, adding frequent vomiting.
In a new evaluation, the temperature was 39.2°C axillary, tachycardic and tachypnea, blood pressure 85/55 mmHg, well hydrated, and no new findings were found on physical examination.
Main laboratory findings: complete blood count with white blood cell count of 15,500/mm3, (neutrophils 82.5%, bacilliforms 2%), hemoglobin 13.7 g/dL, erythrocyte sedimentation rate (HSV) 2 mm/dL
Abdominal ultrasound was reported as normal.
Acute gastroenteritis was diagnosed and outpatient monitoring was indicated.
On the 5th day of evolution she was febrile, with normal digestive tract but with colic abdominal pain.
Blood count with white blood cell count of 7,400/mm3 (bacillus 4%), ESR 29 mm/h and CRP 16.6 mg/dL.
A new abdominal echography showed the presence of intravesical lymphadenopathy masters and echogenic content (flocculations).
Complete urine analysis, immunochromatography for Streptococcus pyogenes pharyngeal, study of respiratory viruses by immunofluorescence (respiratory virus non-pneumonza), adenovirus 1, influenza A-B and target Wiue were negative.
The patient was admitted with a diagnosis of febrile syndrome of unknown origin.
Hemocultive (2) and urocultive (2) were requested, without initiating antibiotic therapy.
feverish tumor and painless in the following hours, severe pain in the bilateral lumbar area that prevented you from getting up from supine to sitting position, without focusing on the specific site
Cloxacillin therapy was initiated and cefoxime iv was suspected for septic spondylitis.
The studies with chest X-ray and echocardiography were normal.
Magnetic resonance imaging (MRI) of the lumbosacral spine detected signs of inflammation in the posterior parasagittal muscles left from T10 to L3, without evident signs of inflammation.
Ultrasound directed to the painful area identified minimal changes in echogenicity and mild hyperemia on color Doppler of the right lumbar muscles, findings considered nonspecific.
1.
The hemocultive was positive for Staphylococcus aureus sensitive to cloxacillin, so cefoxime was discontinued.
The urine culture was negative and the bone scintigraphy Tc 99m MDP was normal.
After 48 h of antibacterial treatment a decrease in the febrile curve and back-lumbar pain was observed, CRP dropped to 6.6 mg/dL on the 6th day and 3.1 mg/dL on the 8th day.
She was discharged in good general condition on the 10th day of antibiotic therapy with cefadroxile after being a week afflicted.
