An 11-year-old boy presents to the emergency department with chest pain and fevers. Two months ago, he had a gunshot wound to his chest requiring pericardiocentesis followed by sternotomy and repair of his right ventricle. He was in the PICU for 1 week and discharged home without any sequelae. He was doing well until 3 days before admission when he developed cough, shortness of breath, chest pain, and generalized body aches. He was seen in the emergency department and was diagnosed as having a viral illness and costochondritis. He had a normal chest radiograph and negative influenza testing. He was discharged home on scheduled ibuprofen, which he has been taking every 6 hours for the past 3 days. On the day of admission, he has an episode of bloody emesis and a temperature of 101°F (38.3°C). He is not having diarrhea and refuses to drink more than a few sips...
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