Case Presentation:
A previously healthy twelve-year-old female presented to the emergency
department at Patan Academy of Health Sciences, Nepal, with a five-day
history of progressively worsening epigastric pain. She reported
multiple episodes of non-bilious, non-bloody vomiting with radiation to
the back. Four days prior, she had experienced a fever, which resolved
spontaneously. On examination, the child appeared pale and icteric and
was in shock with prolonged capillary refill time and hypotension. Two
oral ulcers were noted on the left buccal mucosa, characterized by
whitish coloration with central erythema. There was mild tenderness in
the epigastric region but no organomegaly. Additionally, the patient
exhibited multiple erythematous, non-blanchable petechiae on her limbs,
trunk, and upper extremities.