A 3½-year-old white girl was admitted to Children's Hospital, Cincinnati, Ohio, after a month-long history of persistent spiking fevers and tenderness of her left wrist and left leg. An x-ray film and a bone biopsy specimen from the patient's left wrist showed changes consistent with osteomyelitis. Despite negative bone culture results, a central line was placed, and the patient was treated intravenously with vancomycin and cefotaxime sodium at home. The patient initially did well, but the spiking fevers and severe pain returned.
Schaen L, Sheth AP. Skin Ulcers Associated With a Tender and Swollen Arm. Arch Dermatol. 1998;134(9):1145-1150. doi: