Case Presentation:
A previously healthy twelve-year-old female presented to the emergency department at Patan Academy of Health Sciences, Nepal, with a five-day history of progressively worsening epigastric pain. She reported multiple episodes of non-bilious, non-bloody vomiting with radiation to the back. Four days prior, she had experienced a fever, which resolved spontaneously. On examination, the child appeared pale and icteric and was in shock with prolonged capillary refill time and hypotension. Two oral ulcers were noted on the left buccal mucosa, characterized by whitish coloration with central erythema. There was mild tenderness in the epigastric region but no organomegaly. Additionally, the patient exhibited multiple erythematous, non-blanchable petechiae on her limbs, trunk, and upper extremities.