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

Clinical Infectious Diseases 2009; 48:615–6 2009 by the Infectious Diseases Society of America. All rights reserved. 1058-4838/2009/4805-0016$15.00 DOI: 10.1086/596760 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,