Question: Fever

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You are seeing a 10-year-old girl with sudden onset fever and abdominal pain of one day’s duration. You note that in her chart she has had 3 prior episodes, presenting to the ED with diffuse tenderness, guarding, and rebound; each time she was worked up for appendicitis but not found to have it, and her symptoms abated spontaneously in a few days. She has also had an episode of fever and intense chest pain. In addition to her abdominal pain, she has an erysipelas-like rash on her right ankle today. In a very tangential tribute to Thanksgiving, this disease process is more common in people from Turkey.