A 22-month-old African refugee male was referred to our emergency department by his pediatrician for prolonged fever. He was previously healthy and had just moved from Tanzania to Dallas, TX, 9 months before presentation. He had intermittent high fevers to 103°F, along with chills and night sweats for 7 days. Upper respiratory symptoms, including nasal congestion and cough, were noted for a few days. Review of systems was negative for localized pain, irritability, skin rash, conjunctivitis, dysuria, or choluria. He was still catching up with immunizations.His emergency department (ED) physical assessment revealed a febrile, well-nourished child who appeared non-toxic. Tympanic membranes and oropharynx were clear, and there was no conjunctivitis. Cardiovascular and pulmonary examinations were unremarkable.Abdomen was negative for hepatosplenomegaly or masses. No rashes or peripheral edema were present. Neurologic evaluation was normal.Initial ED diagnostic workup included a hemogram that showed marked leukocytosis with neutrophilia (WBC: 36,100/mm 3 and ANC: 20,700/mm 3 ) and normocytic, hypochromic anemia (hemoglobin 9.1 g/dL, MCV 64 and MCH 21). Urinalysis and chest X-ray were normal. He was admitted for further evaluation of his fever.As an inpatient, testing included a viral respiratory panel, malaria smear, urine culture, blood culture, PPD, and HIV, all of which were negative. Because of the patient's persistent high fevers, an abdominal ultrasound was obtained to rule out an occult abscess or malignant mass. The ultrasound revealed a 4.7 x 3.8 x 5.5 cm complex, hypovascular left renal mass.