‘Always biopsy the abscess and culture the tumour’: An unusual cause of fever in a paediatric patient

Key Points
1. Inflammatory myofibroblastic tumours (IMTs) may present with constitutional symptoms only, with few localising signs to indicate affected organ/s; and variable appearance on radiological imaging.
2. Surgical excision is the mainstay of treatment of IMTs, and recurrence is heralded by return of initial presenting constitutional symptoms such as fever, weight loss and lethargy.
3. Confirmation of anaplastic lymphoma kinase status via immunohistochemistry and specific genetic testing has important therapeutic implications for IMTs, particularly those not amenable to surgical resection or in patients with recurrent tumours.

‘Always biopsy the abscess and culture the tumour’ is a useful aphorism to remind clinicians to consider both infective and neoplastic conditions when in a diagnostic conundrum. Inflammatory myofibroblastic tumours (IMTs) may affect many areas of the body, and when located in the liver can present primarily with constitutional symptoms and fever of unknown origin. We report a case and review the literature.