A 15-year-old previously healthy boy presents to the hospital per the request of his primary care physician. Before this hospital admission, the patient reports 3 weeks of bilateral and intermittent lumbar back pain that began after cutting wood. He characterizes the pain as aching and nonradiating. He notes minimal improvement with directly applying ice to the affected area and taking over-the-counter analgesics. In addition, he reports 2 weeks of fatigue, shortness of breath, and a few episodes of nonbloody and nonbilious emesis. The shortness of breath is associated with activity and relieved with rest. Overall, he has never experienced these symptoms before. He has no urinary complaints, including dysuria, polyuria, increase in urgency and frequency, and changes in urinary color. His medical history is notable for attention-deficit disorder, which is well controlled with a stimulant. His family and social histories are noncontributory.
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