A 10‐Year‐Old Girl with a Rash and Abdominal Pain

Le résumé fourni par la source

A 10-year-old girl was evaluated for a 1-week history of generalized abdominal pain; nonbilious, nonbloody vomiting; and escalating fever (oral temperature up to 40°C). She denied chills, weight loss, diarrhea, or any sick contacts. When her symptoms began, she had recently returned from a 2-month trip to Indonesia and Malaysia. She received hepatitis A vaccination prior to travel. During her trip, she took reasonable hygienic precautions, but she was exposed to animals (including sea turtles, snakes, bats, and eagles), both in the zoo and on a safari. On physical examination, she appeared to be ill but nontoxic. She had diffuse, nonspecific abdominal tenderness and rash (figure 1). The rash was a nonpruritic maculopapular rash comprised of 10-15 lesions, each ∼5 mm in diameter, located on her abdomen. At hospital admission, the rash had been present for 2 days. The patient's laboratory test results were remarkable for an aspartate aminotransferase level of 260 U/L, alanine transaminase level of 210 U/L, total bilirubin of 1.4 mg/dL, alkaline phosphatase level of 858 U/L, and C-reactive protein level of 6.42 mg/L. Abdominal ultrasound findings were normal, and the results of a hepatitis panel were negative. What is your diagnosis?

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