A 16-year-old adolescent presents to the emergency department with a 3-day history of vomiting, tactile fevers, and a mild headache that went away 2 days earlier. The patient denies any abdominal or flank pain, dysuria, diarrhea, or other complaints. When specifically questioned, she acknowledges a slight cough but has no shortness of breath or chest pain.
Vital Signs and Physical Examinations
The patient’s vital signs are normal except for an elevated temperature (100.3 °F) and a pulse rate 133 beats per minute. Initial physical examination is otherwise normal with no rash, tonsillar exudate, rales, murmur, flank tenderness, or other abnormality. Chest radiographs (Figure 1-2) and blood work are ordered. Laboratory results are within normal range except for an elevated white blood cell count (19,000/μL). Pregnancy and COVID-19 PCR tests are negative.
Can you diagnose this condition? What is the most important medical history question to ask?
- Do you vape?
- Any injection drug use?
- Any recent air travel?
- Any new sexual partners?
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