Case 97
With discussion
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CASE 97 (March 2014)

Clinical information

The patient is a 13 months of age child with a clinical picture of a week duration of fever, vomiting and diarrhea, with symptomatic management. Since three days ago has edema, hypertension, anuria and acute renal failure. No obvious central nervous system, although he has drowsiness. No skin lesions.

The laboratory tests show anemia: Hb 6.3 mg/dL, hematocrit 18%, platelets 82,000/mm3, WBC: 18,000. Schistocytes in peripheral blood: +. Coombs negative. Normal serum complement. Metabolic acidosis. Negative blood cultures. Serum creatinine 3.6 mg/dL, BUN 42 mg/dL. He is requiring hemodialysis.

A renal biopsy was carried out. See the images:

Figure 1. H&E, X100.

Figure 2. H&E, X400.

Figure 3. H&E, X400.

Figure 4. H&E, X400.

Figure 5. Masson's trichrome stain, X400.

Figure 6. Masson's trichrome stain, X400.

Figure 7. PAS, X400.

Figure 8. Methenamine-silver stain, X400.

Figure 9.Methenamine-silver stain, X400.

Figure 10. H&E, X400.

Figure 11. Masson's trichrome stain, X400.

Figure 12. H&E, X400.

Figure 13. Immunofluorescence for fibrinogen, X400.

Figure 14. Immunofluorescence for fibrinogen, X400.

Immunofluorescence for IgA, IgG, IgM, C3, C1q: Negative.

What is your diagnosis?

See diagnosis and discussion