A 16-year-old boy suffering from chills, sweats, aching, and lethargy found himself in EDs around the world over the course of a summer's travels, but he could never get a diagnosis—until his mom offered an unusual suggestion, Lisa Sanders writes for the New York Times Magazine.

Your cheat sheet on pediatric telehealth

The symptoms start

At the start of the summer, the boy and his family spent two weeks in Hawaii at their vacation home. Afterward, the boy set off to a two-week music camp on the East Coast: one week at Brown University and a second at Berklee College of Music.

On his second day at camp, the boy started feeling sick, Sanders writes. His head was throbbing, his eyes hurt, and he felt like he was going to throw up. He went to the infirmary, where a doctor told him he probably had a virus. He spent the next two days in bed with chills and sweats.

By the end of the week, the boy felt almost normal—but the day after he arrived at Berklee, he developed a rash on his arms that soon spread to his leg. He visited the infirmary again, where a doctor once again attributed his symptoms to a virus, potentially linked to the illness he had the week before, and prescribed him antibiotics and a steroid.

A new symptom

The boy again began to feel better. But a few days later, a new wave of symptoms emerged: His chest felt tight, and he had aches all over. On his last day of camp, he discovered that his right testicle had become swollen and tender, a condition known as orchitis.

The boy was scheduled to fly to London with his father, where they'd reunite with his mother and brother for a family vacation in Europe. He endured the flight, but by the next morning, he couldn't get out of bed. Two days later, he finally was able to meet his family at a restaurant—but he soon realized he couldn't eat, and he went back to his room.

That's when his mother took him to an ED. There, the doctor focused on his swollen testes. Mumps is the most common cause of the condition, but the doctor ruled out that possibility because the boy had been vaccinated. The doctor's next guess was a sexually transmitted disease, but the boy denied any recent sexual contact, so the doctor prescribed a new antibiotic.

The next day, the boy's symptoms hadn't improved, and his father took him back to the ED. A new doctor told them to stick with the current course of treatment and to come back if the boy couldn't keep his medication down, Sanders writes.

By the end of the week, the boy was able to join his family to fly to Rome for the second part of their vacation. There, his fever returned and his other testicle began to swell, so he found himself in yet another ED. There, the doctor told him he should be tested for sexually transmitted diseases when he got home.

A few days after returning home to Seattle, the boy's mother took him to see his primary care doctor who tested him for a variety of infections, including sexually transmitted diseases. All of the tests came back normal.

Finally, a solution

Three weeks after coming back from vacation, the boy and his mother visited Chia Wang, an infectious disease doctor at Virginia Mason Hospital in Seattle, Sanders writes. By the time the boy was visiting Wang, most of his symptoms were gone. He occasionally felt a twinge in his chest but no pressure, and his appetite had improved, but he still felt extremely tired, as though he'd constantly been working out at the gym.

While sharing the boy's medical history and discussing potential diagnoses with Wang, the boy's mother had an idea: "Could this be dengue fever?" she asked.

Dengue fever is common in many parts of the world, but the mosquitoes that transmit it are rare in the United States. Even so, the mother had heard of an outbreak of dengue fever in Hawaii the year before.

Wang, who initially had suspected the boy's symptoms could stem from the Zika virus, decided to order both a Zika and dengue fever test. And sure enough, the boy tested positive for dengue fever—a diagnosis that Wang felt explained all of his symptoms.

It took six months before the boy fully healed, and even a year and a half later, he still occasionally needs a nap after a full night's sleep. Even so, he is graduating from high school and will be attending New York University in the fall.

But he's not completely out of the woods. Dengue fever symptoms can worsen with each new infection, so he will have to use DEET and protective clothing to avoid mosquitoes the rest of his life. And to reduce their son's exposure to dengue-carrying mosquitoes, the boy's parents decided it was time to sell their Hawaiian vacation home (Sanders, New York Times Magazine, 4/4).

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