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The paper describes the case of a 14-year-old girl with intense right shoulder pain and severe signs of local and systemic inflammation. Magnetic resonance imaging revealed a pyomyositis of right shoulder girdle muscles. Blood culture was found positive for methicillin-resistant Staphylococcus aureus (MRSA) and the chest computed tomography scan revealed nodular infiltrates in both pulmonary fields resulting from septic embolism. A prolonged antibiotic therapy according to antibiogram allowed the complete recovery. Pyomyositis is a deep pyogenic infection of the skeletal muscle tissue and is most commonly caused by Staphylococcus aureus species. In the described case, repetitive trauma due to karate may have caused the initial muscle cell damage with subsequent haematoma, which subsequently becomes colonised by bacteria during a transient bacteraemia. There is an increasing prevalence of pyomyositis in temperate climates and in the last few years MRSA has emerged as a pathogen within the community (CA-MRSA) also in healthy people. An early diagnosis is important to avoid local and systemic complications.

An increase in Group A streptococcal (GAS) infections above seasonally expected levels in children has been recently reported. Since GAS infections and correlated bacterial diffusion always start from an index case, adopting public health strategies based on ready isolation and treatment of GAS cases has become a relevant problem in disease management. A systematic review recently published in Eurosurveillance aimed to estimate the pooled proportion of individuals who remained GAS throat culture-positive at set intervals after initiation of antibiotics. It was shown that antibiotic therapy acts on GAS leading to both clinical and microbiological recovery within 24 hours. This was confirmed for all the proven antibiotics, with amoxicillin remaining the drug of choice. Consequently, the child can return school as early as the day after the beginning of antibiotic therapy, without risks of infection for the community. About the 10% of children can maintain a positive swab after the start of antibiotic therapy: they are the asymptomatic GAS carriers and they are not to be chased. To avoid mistakes, also, asymptomatic children should not undergo GAS throat swab to not receiving further and useless antibiotic therapies.

PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis) is the most common periodic fever syndrome in children. The disease appears to cluster in families, but the pathogenesis is unknown. The paper reports the description of a clinical case of a 12-year-old girl diagnosed with PFAPA syndrome from the age of one and half years. The exacerbations did not decrease with growth as it usually happens, but genital ulcers appeared associated with HLA-B51 positivity, orienting the diagnosis towards Behçet’s spectrum disorders.

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