CW, a 15-year-old African American girl, presented to the ER at Children’s Hospital of New Orleans with severe abdominal pain and a history of diarrhea, fatigue, and weight loss of 6 lb over 4 months. The patient did not have any mouth ulcers or rashes and had no joint pain or swelling. Her past medical history was only positive for eczema. Her cousin had lupus. On examination, the patient was afebrile and had normal blood pressure and regular pulse. Examination of the head and neck did not reveal any lymphadenopathy, alopecia, or ulcers. Her heart sounds were normal, with some left lower precordial pain that was worse with sneezing. Abdominal exam was negative for organomegaly, and there was slight tenderness around the umbilical area. There was no edema, and normal pulsations were present in the lower extremities. No signs of joint swelling or arthritis were present in any joint. There was no evidence of skin rash or mucositis. The patient’s menstrual periods were regular. Laboratory evaluation revealed an erythrocyte sedimentation rate (ESR) of 92 mm/h. Her serum chemistry, including amylase and lipase, was within normal limits. The C-reactive protein level was 2.5 mg/dL. Her white cell count was 4.8, with normal differential, hemoglobin level was 9.6 mg/dL, hematocrit was 30.8%, and platelet count was 419 000. Antinuclear antibody test and rheumatoid factor were negative. The immunoglobulin serum levels showed that IgG was significantly elevated to 2260 mg/dL (normal 510-1275 mg/dL). A CT of the abdomen was ordered, which revealed thickening of the superior mesenteric artery and abdominal aorta (Figures 1 and 2). A magnetic resonance angiography (MRA) image revealed a thickening of the wall of the lower thoracic aorta. Also, the MRA showed a narrowing of the roots of the left carotid, right brachiocephalic artery bilaterally in addition to some pleural effusion, which was greater in the left than the right. The EKG and echocardiogram were normal. No blood or mucus was observed in the stool.