Clinical presentation A nine-year-old boy presented with a complex medical history and fever for three weeks. He appeared pale and had a poor appetite at the time of presentation.
Medical history Phelan-McDermid syndrome Autism spectrum disorder Focal epilepsy Asthma Gastroesophageal reflux disease (GERD) Physical examination High fever- 39.5°C Rhinorrhea Dysuria and oliguria Tachycardic and tachypneic Tender palpitation- From the left side of the sternum to the left anterior shoulder Laboratory findings Leukocytosis (WBC 20.89K) and Reactive thrombocytosis (platelets: 527K) Mild anemia (Hb 8.8 gm/dL, Hct 26.4%) Elevated inflammatory markers (ESR: 111 mm/h, CRP: 20.23 mg/dL) Hypoalbuminemia (2.3 gm/dL) Transaminitis (AST: 137 unit/L, ALT: 235 unit/L) Radiological findings Renal ultrasound- Small fluid collected around the left kidney MRI (abdomen & pelvis)- Loculated, rim-enhanced,…
