Hiding in the Water.

A 59-year-old woman presented to her primary care physician with a 3-month history of dyspepsia and loss of appetite. Her upper abdominal discomfort was sharp in quality, radiated to the right upper quadrant, persisted for 3 to 5 hours, and occurred roughly every 6 days. The discomfort was not associated with eating or moving her bowels; rare episodes woke her from sleep. She reported no nausea, vomiting, weight loss, or change in bowel habits. Two days before presentation, she had a temperature that peaked at 39.9 degrees C, associated with rigors and an erythematous, pruritic rash over her arms, hips, and buttocks. She reported no cough or dysuria.