Case 4-1986

Presentation of CaseAn 18-year-old woman was admitted to the hospital because of nausea, vomiting, arthralgia, and hypotension.She was well until eight weeks earlier, when a sore throat developed at about the time of her menses, accompanied by mild arthralgia and myalgia. A throat culture yielded beta-hemolytic streptococci. Penicillin was administered but was discontinued by the patient after one week because of gastrointestinal symptoms. Four weeks before admission, during her next menstrual period, she again experienced a sore throat, arthralgia, and myalgia, as well as nausea, vomiting, malaise, diarrhea, and a rash. Erythromycin was administered, with resolution of the . . .