Case 2: Fever, Chills, and Abdominal Pain in a 4-year-old Girl

Presentation

A previously healthy 4-year-old girl presents to a pediatrician’s office for evaluation of fever and chills. The mother reports that the patient has not been feeling well for the past couple of days, with nausea, vomiting, decreased appetite, generalized abdominal pain, and decreased urine output. Medical and family histories are noncontributory. The mother and patient recently traveled to India for their yearly 1-month visit to family members and returned approximately 2 to 3 weeks ago. The primary care physician evaluated the patient with a rapid streptococcal test and a throat culture for streptococcal pharyngitis, a rapid antibody test for infectious mononucleosis, and a blood smear for malaria; all of these results were negative. On day 5 of illness, the patient is brought again to the primary care physician's office and is subsequently sent to the emergency department for further management. The patient has continued with persistent fevers and chills for the past 5 days. Her maximum measured temperature was 103°F (39.4°C) at home, and the mother reports that fevers subside with antipyretic use. On physical examination the patient is noted to have unremarkable vital signs, looks well, and has no significant findings. Therefore, the patient is discharged with instructions for supportive care for a likely viral illness given that her mother has tested positive for Epstein-Barr virus. Further blood test results eventually …