A 12-year-old female with a past medical history of asymptomatic, perimembranous ventricular septal defect (VSD) presented to the urgent care with 2 weeks of fatigue, decreased appetite with weight loss, intermittent fever (101°F to 102°F), chills, congestion, cough, and night sweats. She also had occasional headaches, dizziness, nausea, vomiting, diarrhea, and shortness of breath. She denied any chest or abdominal pain. Before these symptoms, she reported a visit to the zoo but denied handling animals or animal bites. There was no recent history of travel, dental work, or intravenous line access. Two weeks before these symptoms, she was diagnosed with acute sinusitis and subsequently treated with amoxicillin/clavulanic acid. On physical examination, she was febrile to 102.7°F and tachycardic. She also had rhinorrhea and a pan-systolic II/VI heart murmur. Her complete blood count demonstrated leukocytosis with white blood cell 31.53 K/µL (normal value = 4.5-13.5 K/µL), anemia with hemoglobin 6.6 g/dL (12-16 g/dL) and hematocrit 20.6% (36% to 46%), and thrombocytopenia with platelet 124 K/µL