Fever with abdominal distension
A two-year-old boy was admitted with a history of fever of two to three months' duration and abdominal distention. He had made several visits to the emergency department with fever and various nonspecific symptoms. Investigations, including a blood count, chest x-ray and urinalysis, were all normal, and the boy was believed to have a viral illness. Ten days before admission, he had anorexia and diarrhea without blood or mucus. He had no vomiting, abdominal cramps, urinary symptoms or behavioural changes. He had been on oral antibiotics (amoxicillin-clavulanate) for six days. Seven months earlier, the family had visited Yemen in the Arab Gulf, where diseases such as malaria, typhoid, brucellosis and visceral leishmaniasis are common. The family had many domestic animals, including goats, sheep and dogs, but did not drink unpasteurized milk. The child had all of his required vaccinations, including bacille Calmette-Guérin.