Acute-Onset Fever and Abdominal Pain Leading to Shock in a Healthy 13-year-old Girl

A 13-year-old girl presents from an outside hospital for evaluation of 10 days of intermittent fever, emesis, abdominal pain, and diarrhea. The patient has a history of immune thrombocytopenic purpura at age 3 years, which resolved after corticosteroid treatment. She was otherwise well until 10 days prior to presentation when she developed several episodes of nonbloody and nonbilious emesis, poor appetite, fatigue, and tactile fevers. Her symptoms persisted with daily subjective fevers in addition to the development of several episodes of nonbloody diarrhea. Four days before presentation, she developed acute-onset, sharp, left upper quadrant abdominal pain. This pain was persistent and progressive over the next 4 days, prompting evaluation at her primary care physician’s (PCP’s) office. En route to her PCP, the patient had a brief episode of syncope without tonic-clonic movements or a postictal period. She was found to be tachycardic at the PCP’s office and was referred to...