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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.

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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.

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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.

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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).

Adapted from: https://www.advisory.com/daily-briefing/2019/04/10/mysterious-illness

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