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Case: 14 year old girl with poor appetite and right lower belly pain

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A 14 year old girl had a two-day history of poor appetite and right lower belly pain. She did not have diarrhea or vomiting. Her vital signs were normal including a normal temperature. The abdominal examination showed tenderness in the right lower quadrant. There was psoas sign and the rectal examination showed pain at the right anterior wall of the rectum. Her blood count showed a WBC of 3,500. Abdominal ultrasound showed enlarged spleen, a left ovarian cyst. The appendix did not fill with barium enema.

Acute appendicitis was suspected. Surgery was done but a normal appendix was found. There were enlarged mesenteric lymph nodes in the belly.

Three days after the surgery she had fever, red throat and enlarged lymph nodes in the neck.

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