10-year-old male child, with no known co-morbidities anda normal developmental history, presented with history offever for 10 days and pain in abdomen for 8 days. The onset ofboth symptoms was insidious. The fever was moderate tohigh grade and not associated with rigors or chills. No peri-odicity was noticed and it subsided temporarily after admin-istration of anti-pyretics. Two days after the onset of feverthepatient started having constant, increasingly severe pain inepigastrium and left hypochondrium that radiated to leftshoulder and aggravated with movement. There was associ-ated anorexia but no nausea or vomiting. There was no pasthistory of abdominal/thoracic trauma or features suggestiveoflocal/systemic infections.Ongeneral examinationthechildwas listless, febrile, temperature being 101 F, and tachypneicwith a respiratory rate of 40/min and heart rate of 110 perminute. Examination of abdomen revealed tender spleno-megaly extending 4 cm below left costal margin. The rest ofphysical and systemic examination was unremarkable.Laboratory investigations showed leucocytosis (23,000/cubicmm with 80% neutrophils). Other routine hematological andbiochemical investigations were normal. Chest radiographwas suggestive of bilateral basal pleural effusion. Serology for