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 X', 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 12.2X109/L with mild neutrophilia (9.37X109/L), C reactive protein of 58 mg/L, and his blood culture was negative. Imaging excluded an underlying bone infection.
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