Just in Time

Abstract

A 15-year-old white girl has been unable to attend school for three months because of excessive fatigue. For the past seven months she had been short of breath during exercise but had no wheezing or cough. During that time she had lost 6.8 kg in weight and had amenorrhea. The family associated the start of the illness with the administration of diphtheria–tetanus and measles boosters. The patient had previously had no important illnesses, and her family history was not remarkable.She was thin and pale. She weighed 40 kg (<5th percentile) and was 155 cm tall (15th percentile). . . .