A 28-Year-Old Woman With Abdominal Pain and Fever

Richard Lucidi, MD; Jordan Hylton, DO

Disclosures

March 31, 2016

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.

Background

A 28-year-old woman (G1P1001) presents to the emergency department after experiencing 14 hours of nonbloody, bilious emesis and constant abdominal cramping along her lower abdomen. She reports that her symptoms worsen with oral intake and denies relieving factors. She has tried oxycodone/acetaminophen at home, without relief. She also notes new onset of watery, nonbloody diarrhea after arrival to the emergency department. She denies any contact with ill friends or family.

The patient was an anonymous egg donor for an infertile couple and just returned from a trip to California, where she had oocyte retrieval 3 days ago. Upon review of systems, the patient notes limited deep inhalation, which she experienced during chest radiography.

The patient is a writer who lives at home with her husband and one child, age 4 years. She denies use of alcohol, tobacco, and drugs. Her last menstrual cycle was 14 days before presentation. She reports a surgical history that included cholecystectomy 5 years ago and a cesarean delivery for transverse lie in the same year. She takes loratadine for seasonal allergies and notes that she took her "trigger shot" before egg retrieval.

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