Etiology of Abdominal and Hip Pain

A 7-year-old boy presented to a community hospital with vomiting and abdominal pain. His past medical history was remarkable for an anaphylactic reaction to penicillin and a long-standing absence seizure disorder, which was well-controlled on phenytoin. The patient had been well until 9 days prior to presentation when he was seen in the nurse’s office at his school after an apparent absence seizure. In the nurse’s office, he complained of fatigue and a severe headache and was found to have a fever of 104.3°F (40.2°C). The patient’s parents spoke with his neurologist and primary care physician, who advised them to take the boy to the emergency department. In the emergency department, a lumbar puncture was unremarkable, and the patient’s fever decreased to 99.0°F (37.2°C). The patient was sent home for follow-up with his primary care physician.