An 11-year-old girl presented to the emergency department with abdominal pain.
No personal history of interest.
She complained of right iliac fossa pain of eight hours duration accompanied by nausea and vomiting.
He had no fever or other symptoms.
Physical examination revealed pain on palpation of the right iliac fossa with contracture and positive Blumberg sign.
Laboratory tests showed mild leukocytosis with neutrophilia.
Abdominal X-ray showed no significant findings.
Acute arthritis was diagnosed and urgent surgery was performed, showing phlegmonous fungal infection and performing phlemonicectomy.
Histopathological analysis of the specimen confirmed this diagnosis.
On the second postoperative day the patient had fever of 38.5 oC and odynophagia without other accompanying symptoms.
Physical examination revealed a hyperemic pharynx.
Neither wound nor route showed inflammatory signs.
Chest X-ray showed no significant findings.
Antipyretic treatment was established.
On the fourth postoperative day, fever of 38 oC persisted despite antipyretics and presented nausea and vomiting, as well as spontaneous epigastric pain and abdominal palpation.
Abdominal ultrasound diagnosed acute acalculous meningitis.
Laboratory tests revealed liver enzyme abnormalities (GOT: 281 U/l; LDH: 496 U/l) and neutrophilia.
Antibiotic treatment was initiated with metronidazole 30 mg/kg/day and cefoxime 140 mg/kg/24 h.
The patient was discharged on the eleventh postoperative day completely asymptomatic.
