A 15-year-old boy has experienced recurrent episodes of fever and vomiting. During this present bout, the fever has occurred every other day,is accompanied by rigors and night sweats, and goes as high as 38.9°C(102°F). He has vomited food several times a day, but there is no history of abdominal pain, urinary symptoms, changes in bowel pattern,respiratory symptoms, or central nervous system changes. The first episode occurred 2 months ago, was similar clinically, and led to treatment at another hospital. He was given intravenous fluids and sent home on an unknown medication. Two weeks prior to admission, he had experienced vomiting, diarrhea,fever, and sore throat.

Physical examination reveals an afebrile boy in no acute distress. His vital signs are normal. Except for slightly dry oral mucous membranes,a complete physical examination yields normal findings. He is admitted and given intravenous fluids. That night, he develops a fever of 40.0°C (104°F). His white...

You do not currently have access to this content.