A 10-year-old boy with cyanotic congenital heart disease was found to have a renal abscess with perinephritic extension. The main presenting features were inability to walk and stand which lead to confusion as septic arthritis of the hip. The diagnosis was made using ultrasonography and computerized axial tomography. All the cultures were sterile. Sterile urine cultures suggested a possible extrarenal source of infection. The abscess was drained percutaneously and the patient responded well to three-week course of antibiotics. The case is described to present the diversity of symptoms in renal abscess and its association with cyanotic