Quiz Page March 2013: A Critically Ill Infant With Sepsis, Respiratory Failure, and Anasarca

A 1-month-old full-term male infant presented with decreased activity, poor appetite, and abdominal distension. Serologic testing during the first trimester of pregnancy showed that the mother was nonreactive upon rapid plasma reagin (RPR) testing, was rubella immune, and had negative results for hepatitis B and C, toxoplasma, and human immunodeficiency virus (HIV) tests. Vaginal/cervical specimens were negative for chlamydia, gonorrhea, and streptococcus group B. On admission, the infant's weight was 3.6 kg, height was 48.5 cm, rectal temperature was 94.7°F, heart rate was 150 beats/min, respiratory rate was 68 breaths/min, and oxygen saturation was 98%. Physical examination revealed generalized anasarca, abdominal distension, hepatosplenomegaly, and diffuse lymphadenopathy. The baby was admitted to the pediatric critical care unit, intubated, and mechanically ventilated. Initial laboratory results are listed in and and included serum albumin level of 1.1 mg/dL and a spot urine protein-creatinine ratio of 27 g/g. A radiograph of the abdomen showed a distended sigmoid loop without air in the distal rectum, and obstruction was excluded by barium enema. Computed tomography of the head showed a subacute left middle cerebral arterial infarct and lytic skull lesions. Imaging of long bones showed diffuse dystrophic changes with significant periosteal reaction. Bone marrow and lymph node biopsies showed massive infiltration with reactive histiocytes. A kidney biopsy was obtained ...
Source: American Journal of Kidney Diseases - Category: Urology & Nephrology Authors: Source Type: research