To the Editor.
—In the April issue of the Archives, Louria et al1 reported on anterior thigh pain or tenderness as a diagnostic manifestation of bacteremia. We recently encountered a similar case, which we believe may cast light on the pathogenesis of such pain.A 51-year-old woman was admitted complaining of fever, malaise, nausea, and myalgia of recent onset. She had undergone mitral valve replacement 16 years earlier and was receiving oral anticoagulants. Physical examination revealed an acutely ill woman with a temperature of 38 °C. Blood pressure was 90/55 mm Hg, heart rate was 92 beats per minute, and a 2/6 murmur was heard over the precordium. Results of the rest of the examination, including funduscopy, were unremarkable. Laboratory findings showed a white blood cell count of 16,500/cu mm, with 85% polymorphonuclear cells; erythrocyte sedimentation rate (Westergren) was 25 mm/hr, and serum lactic dehydrogenase level was 600 IU/L
Klotstein M, Shilo S. Anterior Thigh Pain or Tenderness. Arch Intern Med. 1986;146(6):1226. doi:10.1001/archinte.1986.00360180246042