In fairness, I guess it really doesn't happen very often — the ER doc in my wife's situation commented that she had never seen it before. On the other hand, pulled muscles don't cause fever. I understand a little bit of reluctance to offer antibiotics, as they have been overused, but geez, you have a patient with a fever and in terrible pain, indeed with all the other symptoms of a kidney infection, what's really the downside to going ahead and starting the antibiotic to see what happens? That's how I see it, anyway; I'm not a doctor.