A 7-year-old girl presented with tactile fever, vomiting, periumbilical and right upper quadrant pain for the past one week. The laboratory analysis performed twice in the previous week showed that the patient had 24,000/mm 3 white blood cells, microhematuria, and pyuria.
A urinary tract infection was suspected, and trimethoprim/sulfamethoxazole was prescribed first, and cephalexin was prescribed later owing to no improvement in the symptoms. Physical examination Shotty cervical lymphadenopathy Abdominal tenderness in periumbilical and right upper quadrant regions Liver – Palpable 2 cm under the costal margin External genitalia – Unremarkable Laboratory analysis Leukocytosis – 41,200/ml Alanine transaminase (ALT) – 114 IU/L Hyperbilirubinemia – 1.8mg/dL, direct 1.1 Lactate dehydrogenase (LDH) – 732 U/L Uric acid – Normal Peripheral blood smear test Reactive lymphocytes Smudge cells…
