“I can’t eat,” the 16-year-old boy announced sadly. He and his brother, along with their parents, were in London on vacation. The boy arrived a few days earlier, but he’d felt awful for the two weeks before that. Sitting at the restaurant, the boy looked sick — he was pale and clearly uncomfortable. “I have to go back to the room,” he said. His mother handed him the key, and he limped slowly to the elevators to go back to bed.
That summer had started normally enough. The boy and his family spent two weeks in Hawaii, where they had a vacation home. Then they went back to their year-round home in Seattle to prepare for the rest of what was going to be a busy summer. The boy and his mother set off for the East Coast to look at colleges, and then she dropped him off at a music camp; the first week would take place at Brown University in Providence, R.I., and the second at the Berklee College of Music in Boston.
Feeling Awful
It was on his second day of camp that he started to feel sick. His head throbbed, and his eyes ached. He thought he was going to throw up. At the infirmary, he was told he probably had a virus.
He spent most of the next two days in bed, alternating between shaking chills and drenching sweats. Though still tired, he forced himself out of bed to take part in his long-anticipated camp. He focused on playing his instruments — guitar, piano, saxophone — and by week’s end, he felt almost normal. But the day after he got to Boston, he developed a rash on his arms — a sleeve of strange-looking raised red spots. He sent his parents a picture. When it spread to his leg, they suggested he go to the infirmary.
The doctor there said that it looked like the kind of rash you could get with a virus. Maybe it was linked to the illness he had the week before, or maybe he had picked up something else. The doctor gave him antibiotics — just in case — as well as prednisone, a steroid.
An Odd New Problem
Camp was everything the boy had hoped for — great teachers and great musicians. But after a couple of days, he started to feel sick again. He ached all over; his chest felt strangely tight, as if he were wearing a T-shirt a couple of sizes too small. One afternoon in class, he could barely get up from his chair and had to spend the rest of the day in bed. The next day, the last day of camp, he became painfully aware of a new problem: His right testicle was swollen and incredibly tender. But he had to meet his father at the airport to fly to London to join his mother and brother on vacation. Sitting in the car and then the plane was torture. His groin ached and throbbed no matter how he positioned himself.
The next morning, he couldn’t make himself get out of bed. His parents and brother set out for a day of exploring the city. By the end of the third day, he thought he could manage getting up. They had reservations at the fancy restaurant in the hotel that night. He put on dress clothes he brought for this occasion, but after ordering, the boy realized he couldn’t stay to eat. The very thought of food made his stomach heave. Everything hurt. His right testicle felt as if it were the size of a baseball. He went back to bed, and after dinner his mother took him to an emergency room.
The doctor focused on the tender, swollen testes. Mumps is the most common cause of what is known as orchitis (from the Greek word for testicle) in young boys, but the patient had been vaccinated. At his age, sexually transmitted diseases were the more likely culprits. When the boy denied recent sexual contact, he was given a different antibiotic. The next day, when he hadn’t improved, his father took him back to the emergency room. A second doctor thought the antibiotic treatment made sense and told them to come back if the boy was unable to keep the medication down.
CreditIllustration by Cristina Daura
Stuck in Bed
The boy spent the rest of the week in bed, sleeping and watching British TV. On the last night in London, he was able to join his brother and parents in a restaurant for dinner. It was nice to get out, but after eating he returned to bed. The next day, the family flew to Rome for the second half of their scheduled vacation. The boy still felt unbelievably tired, but he had no fever and no nausea and nothing hurt. As they prepared to head home, though, the boy’s fever returned, and his other testicle swelled. He made one last trip to an emergency room. Again he was reassured, but the doctor added that he should probably be tested for sexually transmitted diseases when he got home.
A couple of days after returning to Seattle, his mother took him to his primary-care doctor. He tested him for a variety of common infections, including mumps, Lyme disease and, of course, sexually transmitted diseases. Everything came back normal.
What the Right Tests Tell
Three weeks after returning from vacation, mother and son — pale and 15 pounds thinner than he was in June — made their way to see Dr. Chia Wang, an infectious-disease doctor at Virginia Mason Hospital in downtown Seattle.
Wang listened to the strange litany of symptoms that plagued the boy’s summer. Most were gone by now. He had the occasional twinge in his chest, but not the pressure. His appetite was better, and his testicles were back to normal. But he still felt so tired — not as though he hadn’t slept, but as if each part of his body was worn out, the way you feel after going to the gym. Of course, he added, he was still too tired to actually go to the gym.
Wang sent off a few blood tests to see if she could figure out what he had, focusing on infections that he hadn’t been tested for, including the Zika virus, which was first seen in the United States the summer before, and ehrlichia, a tick-borne infection that can cause persistent fevers and is common on the East Coast. Neither was known to cause orchitis.
The Mother Adds a Thought
“Could this be dengue fever?” the mother asked Wang. Dengue is the most rapidly spreading mosquito-borne illness in most parts of the world. It is rare in the United States, because the species of mosquitoes that transmit the virus, Aedes aegypti and Aedes albopictus, don’t thrive here. But the mother had heard there was an outbreak in Hawaii the year before.
The mosquito that carries Zika also carries dengue, so Wang thought it made sense to order both tests. Both viruses cause a febrile illness, with body aches and usually a rash — though in Zika, the symptoms are often less severe. There are no medications for these viral infections, just supportive care. Wang told the boy and his mother that it probably wouldn’t matter which infection he had, because he looked as though he was recovering. And even if it wasn’t a virus but had been a bacterial infection, he had already taken weeks’ worth of the most beneficial antibiotics.
But as it turned out, it did matter. Test results indicated that the boy had had dengue fever. And for reasons that are only beginning to be understood, a second infection of the dengue virus is often much worse than the first. A small percentage of those who have already been infected are eight times as likely to develop a potentially deadly form of the disease — dengue shock syndrome — should they ever get it again. The boy would have to use DEET and protective clothing to avoid mosquitoes that might carry dengue for the rest of his life. Wang had done some investigating and found two case reports of dengue causing orchitis, so she felt confident that dengue explained all his symptoms.
Finding Normal
It took the boy a good six months before he felt fully himself. And even now, a year and a half later, he sometimes needs a nap even after a full night of sleep. Still, he will be graduating from high school this spring and heading to New York University in the fall.
His parents had considered selling the house in Hawaii for some time, but the son’s diagnosis sealed the deal. They sold it to a lovely family, who eagerly anticipate years of beautiful vacations — with lots of mosquito protection.