Not Your Ordinary Teenage Girl With Chest Pain

A 15-year-old female presented to the emergency department (ED) with chest pain. One month ago, the patient was noted to have cough, congestion, intermittent fever, and night sweats with a decrease in appetite. She was seen by her pediatrician at that time and sent home with chest wall pain and treated with oral corticosteroids. A week later, the patient’s chest pain had persisted, prompting the patient’s pediatrician to obtain a chest x-ray, which showed large right pleural effusion (Figure 1). Patient was sent to the ED for further evaluation. Patient’s medical history was notable for pityriasis rosea and chronic iron deficiency anemia. The patient had no history of surgeries and no allergies, and her birth history was unremarkable. Her family history was notable for mother with kidney stones and a paternal aunt with type I diabetes mellitus. Review of systems was positive for fever, chills, 10 pounds weight loss (over 1 month), fatigue, congestion, rhinorrhea, cough, shortness of breath, nausea, and headache. On arrival to the ED, vital signs included blood pressure of 138/85, pulse 114 bpm, temperature 98.3°F (36.8°C) oral, respiratory rate 22 breaths/min, and oxygen saturation 98% on room air. Physical examination was remarkable for decreased breath sounds on the right tachycardia and cervical adenopathy, with no organomegaly noted. Laboratories showed white blood cells (WBC) of 4.6 bil/L, hemoglobin 10.7 g/dL, mean 1161580 CPJXXX10.1177/00099228231161580Clinical PediatricsGoyal et al research-article2023