To the Editor: A 35?year?old female was admitted with a 6?day history of fever and sore throat. On admission, she was feverish, with a temperature of 40.2℃ by rectum. Her pulse was regular at 90 beats/min, and blood pressure was 93/69 mmHg. Other findings were vomiting, abdominal pain, and a macular rash across the upper trunk. She also had abdominal tendess in the right upper quadrant and epigastrium without guarding.