A 16-Year-Old Girl With Severe Abdominal Pain After a Hug

Elena Zafirova, MD; Milcho Panovski, MD, PhD

Disclosures

October 14, 2019

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 that you would like to suggest for a future Case Challenge, please contact us.

Background

A 16-year-old girl in Macedonia presents to the local emergency department (ED) with a sudden onset of severe abdominal pain following what she describes as a "bear hug from a friend." The pain began a couple of hours before arrival to the ED. She describes the pain as sharp, constant, most intense in the right upper quadrant, and radiating to her right shoulder.

The patient also reports having mild, dull abdominal discomfort and a feeling of progressive abdominal fullness for the past few months but has not sought medical attention for these symptoms. She also complains of having a diffuse, itchy rash that seems to have appeared around the same time as the onset of the abdominal discomfort.

The patient has no history of food allergy and has not eaten any new foods before this episode. She denies having any fevers, nausea, or abnormal bowel movements. She has not had any changes in her skin coloration. She reports occasional use of acetaminophen in the past 2 weeks for the abdominal discomfort but is not otherwise taking any regular medications. She has no chronic medical conditions or past surgical history. She reports no significant family history. She has two dogs that she cares for in her house, but no other pets are present.

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