Point-of-Care Ultrasound to Diagnose Pyomyositis in a Child.

We report a case of a patient presenting with fever, right lower leg swelling, and pain who was found to have a fluid collection between muscle planes noted on point-of-care ultrasound. Point-of-care ultrasound raised the clinician's concern for deep musculoskeletal infection, leading to prompt initiation of antibiotics and magnetic resonance imaging.

Gastric artery apoplexy presenting as an acute abdomen in an adolescent.

Nontraumatic abdominal apoplexy, which is the occurrence of hemorrhage into the peritoneal cavity, is uncommon in the pediatric literature. Adult case reports of nontraumatic abdominal apoplexy include visceral artery aneurysms from the aorta, splenic, celiac, hepatic, gastric, and gastroepiploic arteries as well as gynecologic pathology. We identified 2 case reports of spontaneous abdominal apoplexy due to injury of the short gastric arteries in adult patients with histories of vomiting after alcohol consumption. This is the first reported case of nontraumatic abdominal apoplexy due to injury to the short gastric arteries in a pediatric patient.

Clinical deterioration among patients with fever and erythroderma.

BACKGROUND: Some children who present with fever and erythroderma have rapid clinical deterioration or progress to toxic shock syndrome. Our primary objective was to determine whether specific clinical features of those who present with fever and erythroderma can predict who will develop hypotension or progress to toxic shock syndrome. Our secondary objective was to describe the clinical presentation, course, and outcome of children with fever and erythroderma. METHODS: We conducted a medical chart review of children < or = 19 years of age with fever and erythroderma who presented to an urban pediatric emergency department over 60 months. Historical, clinical, and laboratory data were abstracted from the medical chart. RESULTS: Fifty-six patients with fever and erythroderma were studied. Eighteen percent of patients presented with hypotension. Thirty-three percent of the remaining patients who were normotensive on arrival developed shock. Fifty-two percent of patients with hypotension required vasopressor support. The most important predictors of developing hypotension after presentation were: age > or = 3 years, ill appearance, vomiting, glucose > or = 110 mg/dL, calcium < or = 8.6 mg/dL, platelets < or = 300,000/microL, elevated creatinine, polymorphonuclear leukocytes > or = 80%, and presence of a focal infection. Among all patients studied, 4 variables were determined to be the most important predictors of developing toxic shock syndrome: age > or = 3 years, ill appearance, elevated creatinine, and hypotension on arrival. CONCLUSIONS: Overall, 45% of patients with fever and erythroderma developed shock, including 33% of those who were normotensive on presentation. Older age, presence of vomiting, identification of a focal bacterial source, as well as specific laboratory parameters can be used to help predict which patients are likely to have hemodynamic deterioration. Given the high rate of clinical decompensation, all of the patients with fever and erythroderma should be hospitalized, closely monitored, and managed aggressively.