Clinical History.—This 6-month-old male infant was seen with a generalized convulsion, mild cough, and epistaxis. Perinatal and past history were unremarkable. He was one of a family of eight children, all of whom were well.
Physical Examination.—The infant was alert and well nourished, but pale, with mild fever (37.4 C). Mild bronchiolitis/bronchopneumonia was confirmed roentgenographically. Cerebrospinal fluid examination was normal. Twenty-four hours later, he had another generalized convulsion. Further investigations revealed renal failure, with a BUN level of 100 mg/100 ml, metabolic acidosis, hyponatremia, and hypocalcemia. The hemoglobin level was 5.5 gm/100 ml; WBC, platelet, and reticulocyte counts were normal. A blood smear showed schistocytes and burr cells.
Urine examination showed 1+ proteinuria, 3+ glycosuria, and a few granular casts, but no cellular elements or crystals. Treatment for renal failure, peritoneal dialysis, and blood transfusion resulted in improvement in his condition, but severe oligoanuria persisted.
Young LW, Wiggelinkhuizen J, Sinclaire-Smith C. Radiological Case of the Month. Am J Dis Child. 1978;132(5):517-518. doi:10.1001/archpedi.1978.02120300077016