Abstract
A 16-year-old girl presented to the emergency department with intermittent fevers and worsening abdominal pain of 5 weeks duration. She had a history of travel to a less developed country and exposure to possible infectious diseases. Abdominal imaging and blood tests revealed diffuse mesenteric lymphadenopathy, elevated transaminases, and elevation of inflammatory markers. Gastroesophageal and colon endoscopies revealed gastric ulcers, and the patient was discharged with a presumptive diagnosis of systemic juvenile idiopathic arthritis given the lymphadenopathy seen on imaging, serositis, sacroiliac joint stiffness noted on physical examination, and pain relief with celecoxib. She presented again 4 days later with worsening abdominal tenderness, elevated transaminases, and new-onset abdominal distention. Tissue biopsy yielded the diagnosis and directed appropriate treatment.
Copyright © 2019 by the American Academy of Pediatrics.
Publication types
-
Case Reports
-
Research Support, N.I.H., Extramural
-
Research Support, Non-U.S. Gov't
MeSH terms
-
Abdominal Pain / etiology*
-
Adolescent
-
Animals
-
Anti-Inflammatory Agents, Non-Steroidal / adverse effects
-
Antineoplastic Combined Chemotherapy Protocols / therapeutic use
-
Arthritis, Juvenile / diagnosis
-
Biomarkers / blood
-
Biopsy
-
Diagnosis, Differential
-
Emergency Service, Hospital
-
Endoscopy, Gastrointestinal
-
Enterobiasis / diagnosis
-
Female
-
Fever / etiology*
-
Humans
-
Inflammation / diagnosis
-
Lymphadenopathy / diagnosis
-
Lymphoma, Large-Cell, Anaplastic / diagnosis*
-
Lymphoma, Large-Cell, Anaplastic / diagnostic imaging
-
Lymphoma, Large-Cell, Anaplastic / drug therapy
-
Lymphoma, Large-Cell, Anaplastic / pathology
-
Positron Emission Tomography Computed Tomography
-
Stomach Ulcer / chemically induced
-
Stomach Ulcer / diagnosis
-
Tomography, X-Ray Computed
-
Transaminases / blood
Substances
-
Anti-Inflammatory Agents, Non-Steroidal
-
Biomarkers
-
Transaminases