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Images in paediatrics
A not so innocuous playground fall: lymphocutaneous nocardiosis in an immunocompetent boy
  1. Phoebe C M Williams1,2,3,
  2. Adam William Bartlett2,3,
  3. Pamela Palasanthiran2,3,
  4. Brendan McMullan2,3
  1. 1 School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
  2. 2 School of Women and Children's Health, The University of NSW, Sydney, New South Wales, Australia
  3. 3 Department of Infectious Diseases and Immunology, Sydney Children's Hospital, Randwick, NSW, Australia
  1. Correspondence to Dr Phoebe C M Williams, Department of Infectious Diseases and Immunology, Sydney Children's Hospitals, Randwick, NSW 2031, Australia; phoebe.williams{at}sydney.edu.au

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An otherwise well, fully immunised 9-year-old boy presented due to systemic malaise with an infected knee laceration 10 days after falling onto concrete in his school playground. On examination his growth parameters were age-appropriate; he was febrile to 39.1℃, with purulent exudate oozing from his knee (figure 1). There was evidence of nodular lymphangitis with lymphocutaneous spread (figure 2). Investigations revealed white cell count of 12.2×109/L with mild neutrophilia (9.37×109/L), C reactive protein of 58 mg/L, and his blood culture was negative. Imaging excluded an underlying bone infection.

Figure 1

The …

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Footnotes

  • Twitter @phoebwill

  • Contributors BM conceived the paper. PCMW wrote the first draft. All authors were involved in the management of the patient and reviewed and commented on the manuscript draft and resubmission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.