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December 1985

Thigh Pain and Bacteremia

Arch Intern Med. 1985;145(12):2271. doi:10.1001/archinte.1985.00360120143042

To the Editor.  —In the April 1985 issue of the Archives, Louria et al1 described four patients with bacteremia and anterior thigh pain and tenderness. The authors concluded that this constellation of signs and symptoms should be the basis for institution of antibiotic therapy in patients with other signs of an infectious process, such as fever, chills, and sweating. Enumerated in the differential diagnosis were leptospirosis, bacterial endocarditis, viremia, rickettsial infections, sickle cell anemia, and vasculitis, but, to my surprise, disseminated candidiasis was omitted.Myalgias and myositis have been well described as one part of a clinical triad, which also includes fever and an erythematous papular rash.2-4 Many of these patients have had anterior thigh pain and tenderness as a sign of sepsis. While it is true that these patients have been in various states of immunosuppression, this in no way detracts from the utility of this finding,

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