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Acute lobar nephritis (ALN) is a focal interstitial bacterial infection of the renal parenchyma. ALN is described as a midpoint between an acute pyelonephritis and renal abscess. ALN is underdiagnosed in children due to both non-specific symptoms and negative urinalysis/bacteriuria laboratory findings. The gold standard for diagnosis of ALN is CT scanning, however MRI can be considered to avoid radiation exposure. Diagnosing ALN is relevant, because it requires prolonged antibiotic treatment. Insufficient antibiotic treatment could cause renal scarring and subsequent hypertension or renal failure. Outpatient follow-up is indicated to exclude congenital urogenital abnormalities. We describe two paediatric patients with acute abdominal pain and fever who were suspected to have appendicitis (appendix not visualised by ultrasonography), but eventually were diagnosed with ALN and a renal abscess (despite absence of pyuria). These reports serve to highlight the issues around the recognition and diagnosis of ALN in children, and the need for clinicians to be mindful of this condition.

Background: Osteomyelitis is usually caused by an infection. A non-infectious cause should be considered if antibiotic treatment is insufficiently effective and disease is recurrent, multifocal or migrating., Case Description: A 14-year-old girl, an active volleyball player, developed episodes of fever and pain in her right lower leg. MRI showed osteomyelitis in her right tibia. She received prolonged intravenous antibiotic treatment. Shortly after recovery, she developed osteomyelitis in her left lower leg. After exclusion of infection and malignancy, we diagnosed chronic recurrent multifocal osteomyelitis (CRMO). The patient was successfully treated with a NSAID and a bisphosphonate., Conclusion: CRMO is an auto-inflammatory condition characterised by recurrent, non-infectious, multifocal or migrating osteomyelitis. Patients experience recurrent episodes of bone pain, sometimes accompanied by fever and slightly elevated infection parameters. The disease course usually is self-limiting, without residual damage. Symptomatic treatment with NSAIDs and bisphosphonates often leads to remission.