Red Book Online Presents: Diagnosis Detective | November 2024
Editor: Kristina A. Bryant, MD, FAAP
Case contributed by Shreya Doshi, MBBS, FAAP, Children’s National Hospital, Washington DC
An 11-year-old girl presents with a 2-week history of daily fevers, abdominal pain, and alternating diarrhea and constipation. She had just returned from a 6-week trip to Pakistan, where she was treated empirically for malaria when the fevers started. Her symptoms persisted despite treatment. She had contact with goats, parakeets and chickens while in Pakistan. She also drank tap water and consumed a variety of street foods. On physical examination, she has a temperature of 39°C, mild abdominal tenderness, and hepatomegaly. There is no rash or lymphadenopathy, but the patient appears fatigued.
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