A 13-Year-Old With Fever and Chest Pain.

Abstract

A 13-year-old boy with a recent diagnosis of ulcerative colitis presented with fever and chest pain to the emergency department. The sharp pain had begun 2 days previous and radiated to his shoulders. It was constant, although it improved with sitting up and leaning forward. On the day before, he had developed a fever to 38.3°C. His past medical history was notable for a diagnosis of ulcerative colitis 2 months before presentation. For this, he was taking mesalamine and rectal hydrocortisone and weaning down on a prolonged course of oral prednisone. On examination, he was noted to be in mild distress, febrile, and tachycardic, with a heart rate of 120 beats per minute. Aside from the tachycardia, his cardiac examination was largely unremarkable. An electrocardiogram revealed diffuse ST elevations in the precordial leads. Blood testing revealed an elevated white blood cell count of 19.1 × 1000 per µL, with 78.9% neutrophils, hemoglobin of 8.3 g/dL, and a platelet count of 628 × 1000 per µL. Troponin T was elevated to 0.46 ng/mL. A rapid bedside cardiac ultrasound was grossly normal. He was admitted to the hospital with a diagnosis of pericarditis and treated with an increased dose of prednisone. Despite this treatment, he experienced rapid clinical deterioration. After considering the broad differential diagnosis, the correct etiology was identified, and steps were taken that led to a swift clinical improvement.