Urachal sinus leading to pyourachus presenting as recurrent periumbilical sepsis in an infant

Description

A 5-month-old female infant presented with an 8 days duration of fever and irritability. In the previous 48 hours, she developed a rash around her umbilicus with reduced feeding and wet nappies (figure 1). She was born at 38+3/40 weeks gestation by caesarean section for breech presentation. At 4 months of age, she had gastro-oesophageal reflux. She initially presented to the general practitioner (GP) at 3 months of age with redness around the umbilicus and dried clots in the centre without any swelling. She had no fever and was otherwise well. Initial treatment given by GP included a 1-week course of oral flucloxacillin for provisional diagnosis of infected umbilical granuloma. This seemed to have resolved her symptoms.

Figure 1

Clinical photograph showing a diffuse periumbilical erythema.

The baby was referred for paediatric assessment by her GP with recurrent symptoms mentioned above. On examination,...

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