• Samantha L Simpson, Kathryn Clarkston, Victoria M Wurster Ovalle, and Jennifer L Reed.
• From the Pediatric Residency Training Program, Cincinnati Children's Hospital Medical Center.
• Pediatr Emerg Care. 2021 Dec 1; 37 (12): e1733e1734e1733-e1734.

AbstractA 7-year-old female patient presented to our pediatric emergency department with 5 days of fever, sore throat, abdominal pain, vomiting, headache, and 2 days of periorbital swelling. Her initial laboratory evaluation revealed a negative monospot test, neutropenia, atypical lymphocytosis, and thrombocytopenia in addition to transaminitis and proteinuria. An abdominal ultrasound obtained identified hepatosplenomegaly, moderate ascites, acalculous cholecystitis, and a distended appendix with periappendiceal fluid. She was admitted to gastroenterology for further management with antibiotics and surgery and hematology consults. Ultimately, Epstein-Barr virus polymerase chain reaction was positive. This case highlights an atypical presentation of Epstein-Barr virus and the collaborative approach to diagnosis.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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