Young Woman With Fever and Abdominal Pain

Abstract

A healthy 17-year-old girl presented to the emergency department because of 1 week of intermittent fevers and progressive abdominal pain, with one episode of nonbilious vomiting. Her temperature was 38 °C, pulse rate 118 beats/min, and blood pressure 101/53 mm Hg. She had a positive Murphy’s sign. She had a WBC count of 10,000/uL (76.9% lymphocytes and 27.1% atypical lymphocytes) and increased alkaline phosphatase levels (728 units/L). Abdominal sonography disclosed thickened gallbladder wall with a gangrenous appearance (Figure 1), and the diagnosis was confirmed by computed tomography (Figure 2).