From:   Daum: N Engl J Med, Volume 357(4).July 26, 2007.380-390

Figure 1. Anterior Abdominal-Wall Abscess in a 15-Year-Old Boy. There was a 3-day history of drainage from this abscess, which had increased in size to 1 cm in length and become more painful. It was fluctuant and tender on examination. Incision and drainage were performed; about 2 ml of purulent material was obtained. A culture yielded MRSA that was susceptible to clindamycin. The results of the D-zone test were negative .

Figure 2. Swelling and a Small Amount of Drainage Involving the Left Naris in a 10-Year-Old Girl. There was a 5-day history of drainage from the lesion. The child appeared well and did not have a fever. Incision and drainage yielded 0.5 ml of purulent material. A culture yielded MRSA that was susceptible to clindamycin. The results of the D-zone test were negative .

Figure 4. Buttock abscess in a 22-month-old boy. The abscess had increased in size over 2 days. A previous buttock abscess had required therapy 6 months earlier. On physical examination, he was afebrile. The right buttock had an area of fluctuance 1.5 cm in diameter surrounded by erythema, warmth, and tenderness approximately 5 cm in diameter. Incision and drainage was performed, yielding approximately 3 cc of purulent material, and the wound was loosely packed. Oral clindamycin was prescribed. Culture of the purulent material revealed S. aureus, resistant to methicillin, susceptible to clindamycin. The D-zone test was negative.

Figure 5. Rapidly progressive left sided neck swelling in a 9-month-old boy. He had a 2-day history of increasing swelling and tenderness, and possible fever. One examination, he was afebrile and appeared mildly ill, but not toxic. Erythema and tenderness extended approximately 10 cm. A CT scan of the neck revealed a multiple, loculated abscesses. The child was hospitalized; intravenous clindamycin was administered and incision and drainage was performed under general anesthesia. Culture of the material obtained at surgery revealed S. aureus, resistant to methicillin, susceptible to clindaymcin. The D-zone test was negative.

Figure 6. Rapidly progressive swelling of the left labia majora in a 10-month-old girl. A small amount of spontaneous drainage from the inferior aspect of the labia was noted prior to presentation to the emergency department. On physical examination, the child was fussy and illappearing. The temperature was 40.1 degrees C. The lesion was 8 cm in diameter with surrounding erythema and warmth extending 2 to 3 cm lateral to the inguinal crease, but not fluctuant. Attempted incision and drainage yielded a scant amount of fluid. The child was started on intravenous clindamycin and admitted to the hospital. Culture revealed S. aureus, resistant to methicillin, susceptible to clindamycin. The D-zone test was negative.
 

Figure 7.  Abdominal wall abscess approximately 4 cm in diameter in a 6-year-old boy with a history of increasingly painful swelling near the umbilicus. The child was well-appearing and afebrile. Incision and drainage revealed a large amount of purulent material. Culture revealed S. aureus, resistant to methicillin, susceptible to clindamycin. The D-zone test was megative.