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A 17-year-old female presents to the emergency department with progressive fatigue and dyspnea. She denies chronic medical illness and takes only oral contraceptives. She was treated by her local physician for pneumonia 2 weeks ago with azithromycin. She noted initial improvement but began to feel ill again 3 days ago. Physical exam is remarkable for a pale-appearing female with faint scleral icterus. Her temperature is 36.9 C, pulse 110, blood pressure 120/62, respirations 14. Her pharynx is clear. Heart rhythm is regular, but tachycardic. Lungs are clear to auscultation bilaterally. Her abdomen is soft, with a palpable liver edge and minimal right upper quadrant tenderness. You obtain a CBC, which demonstrates WBC 6,000/mm3, hemoglobin 9.2 g/dl, and platelet count 300,000/mm3. Her electrolytes are within normal range, and her transaminases are 5 times the upper limits of normal. You obtain titers for mycoplasma, which are suggestive of an acute infection.