Tibial osteomyelitis with cold abscess within calf muscles in a toddler referred with suspected oligoarthritis to rheumatology clinic

Description 

A 2-year-old male child was referred to the paediatric rheumatology clinic with history of limping, swelling of right knee and low-grade fevers for 6 weeks. About 2 months prior to this presentation, he had an episode of upper respiratory infection which was followed by swelling of the right knee. He was initially treated with oral analgesics by his primary physician. After 6 weeks when there was no improvement, he was referred for evaluation of possible juvenile idiopathic arthritis.

On examination, there was visible swelling of his right knee compared with his left and he was refusing to bear weight on his right lower limb (figure 1). On closer observation, a diffuse swelling was noted over the right calf region with fullness of the popliteal fossa (figure 1). The swelling was not warm or tender. There was no contact history with tuberculosis. The patient...

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