Abnormal segmental hot and cold lesions in the kidneys were seen on bone imaging of a 6-year-old boy who had the diagnosis of hemolytic streptococcal septic/toxic shock syndrome. This patient presented after 6 days of fever, vomiting, and diarrhea. On the fourth day, left shoulder and arm pain developed. Radionuclide Tc-99m MDP bone imaging was performed to rule out osteomyelitis. The study demonstrated a cold area of osteomyelitis in the left humerus and abnormal kidneys with enlargement and focal areas of increased and decreased tracer accumulation. Hemolytic streptococcus was recovered from the blood, left humerus, and urine.
From the Children's Hospital of Wisconsin, Department of Pediatric Radiology, Milwaukee, Wisconsin