A 12-year-old boy presented to the clinic with fever and epigastric pain. He had been suffering from intermittent fevers and coughs for the last three weeks. Physical Examination: Temperature - 36.6°C Heart Rate - 138 beats/min Respiratory Rate - 40 breaths/min Blood Pressure - 121/84 mmHg He appeared to be ill and abdominal examination revealed abdominal distension, hepatomegaly, and diffuse tenderness. Cardiopulmonary physical examination showed pericardial friction rub but no gallop or murmur, diminished bibasilar breath, subcostal retractions and clear lung fields.
Oral examination was unremarkable. Laboratory tests: White Blood Cell count - 31 × 10(3)/mcL Hemoglobin - 9.7 gm/dL ESR - 78 mm/hr CRP - 202.9 mg/L AST - 939 units/L ALT - 351 units/L INR - 3.3 Lactate 6.9 mmol/L Echocardiogram showed diffuse ST-segment elevations and PR-segment depressions. Chest X-Ray image has been…
