A 16-year-old male presented to the ED complaining of suprapubic
pain radiating to the right testicle, dysuria, urgency and
frequency for eight days. The patient was seen one week
prior to his ED visit by his primary care provider (PCP), at
which time he described the previous complaints as well as
subjective fevers. At that time, the patient’s temperature was
99.2◦F (37.3◦C). He was noted to be well appearing and in no
acute discomfort. The abdominal examination revealed mild
suprapubic tenderness to palpation without the presence of
rebound or guarding, no costovertebral angle tenderness
(CVAT) was noted and his genitourinary (GU) examination
was normal. A urinalysis was negative for infection and the
patient was diagnosed with a viral syndrome.
Three days prior to his ED presentation, the patient reported
a temperature of 103◦F (39.4◦C) and severe suprapubic
pain. The following day, the intensity of his pain diminished
somewhat and his fever resolved. In the ED, the patient
continued to complain of crampy abdominal pain at a level of
6 (on a scale of 0 to 10), with associated dysuria, urgency and
frequency. He denied nausea, vomiting, diarrhea, constipation
or penile discharge, and was tolerating oral liquids.