A 10-year-old girl presents to the emergency department with 4 days of fever, headache, and malaise. Her fevers (up to 102°F [38.9°C] at home) are responsive to antipyretics, and her headache is described as a left temporal throbbing sensation. She denies vomiting, diarrhea, skin rashes, or joint pain. Her immediate medical history includes an 8.2-lb (3.7-kg) weight loss and a normocytic anemia noted during the past 6 months. She is currently undergoing an outpatient evaluation by gastroenterology, nutrition, and hematology without a definitive diagnosis. She takes no medications, has no pets, and has no history of recent travel. Her family history is negative for rheumatologic diseases and malignancies.

In the emergency department she is febrile to 102°F (38.9°C), tachycardic to 175 beats/min, tachypneic to 44 breaths/min, and hypertensive to 129/95 mm Hg. Her weight is 50.3 lb (22.8 kg), a drop from the 28th percentile 6 months ago to the...

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