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May 1978

Radiological Case of the Month

Author Affiliations

From the Departments of Paediatrics and Child Health and Pathology, University of Cape Town (South Africa) Medical School.

Am J Dis Child. 1978;132(5):517-518. doi:10.1001/archpedi.1978.02120300077016

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.

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