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Posted On : 05 Jan 2012

Male - 7months old - well child -
Immunised as per schedule incl Prevenar, Rotarix and Hiberix-DTPa-IPV regularly given
Fever 10 days - Acetaminophen periodically given.
Rash - diag as viral eruptive fever first - probably roseola entero virus.
Syr.Mox given for 10days.Fever subsided.
But Rt axilla - suppurative lymphadenitis with an abscess

Investigation: Bld culture No growth
CBC normal except leucocytosis woth ploy morph increased.
KAWASAKI and Kochs ruled out.
NO hepato spelomegaly.
From 11thday afebrile.
From 11th day Clindamycin given for 14 days.
Meanwhile during clinda therapy FNAC of the swelling done- Yellowish green pus was drawn -
Culture was sterile and Atypical kochs also ruled out.
Still the swelling has not completely subsided
Today is the 27th day
Abscess not completely subsiding.
Qn: 1} Another antibiotic needed_?
2}Surgery needed_?
3} repeat needling needed_?

Expert Answer :

Answer Discussion :

T

Thanakornn Chitanondh

0

Vancomycin should be tried for treatment of S.aureus and optimum drainage should be considered.
Repeat needling is un necessary after long period of antibiotic treatment for the initial organism might be changed.

13 years ago

M

Monraj

0

i think the lymphadenitis should be considered of infective in origin ..and proper i.v antibiotic should be given for 10 days...covering grampositive organisim..i think rash could be of streptococcal infection..

13 years ago

L

lakshitha samaranayake

0

partially treated kochs due to clindamycin.....

13 years ago

R

Rolando Lezama

0

Surgery needed like treatmt and Dx.

13 years ago

V

vanmathi chandran

0

surgery needed followed by antibiotics

13 years ago

Answer 1

Antibiotic with staph cover such as Linezolid or Cloxacillin and anaerobic cover such as Metronidazole may be needed. Since abscess is not subsiding even with 27 days of antibitiotics, one should send abscess culture again, rule out immunodeficiency such as HIV, immunoglobulin defects, hyper IgE, CGD etc.

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