26th February 2025

You see a 23-year-old male of Armenian origin on the medical take where he has been referred with acute fever and abdominal pain.

You see a 23-year-old male of Armenian origin on the medical take where he has been referred with acute fever and abdominal pain. This came on abruptly 18 hours ago. He has had multiple episodes like this before; however most have resolved without any intervention in less than 12 h. He has been to the emergency department in the past with chest pain and was diagnosed with a pleural effusion at this time. He also tells you he had his appendix removed when he was 8 years old, which was later found to be histologically normal.

On examination, you find generalised abdominal tenderness with guarding and a temperature of 38.5 degrees Celsius. There is no skin rash or mouth ulcers.

What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.