A 16-year-old boy with rapidly progressing pulmonary fibrosis

Abstract

A 16-year-old boy with no chronic medical illness was evaluated for fever, cough, shortness of breath, and epigastric pain exacerbated by inspiration. Nine days before this admission, the patient had a sore throat, vomiting, diarrhea, and decreased intake of fluids because of mouth sores. After 2 days of illness, he was admitted with dehydration to a local hospital. His blood urea nitrogen was 86 mg/dL, and his creatinine was 8.4 mg/dL. Renal failure was attributed to either acute tubular necrosis or to poststreptococcal glomerulonephritis. Additional studies during this first admission included a white blood cell count of 18,000 cells/mm3, proteinuria of >300 mg/dL, and an elevated circulating C3 component of complement of 127 mg/dL (reference range: 51-95 mg/dL). Blood culture, urine culture, and throat culture for group A β-hemolytic streptococci were all negative, as were tests for antinuclear antibody, antistreptolysin O antibody, heterophile antibody, and stool culture. A renal ultrasonogram was normal. The patient received intravenous fluid therapy and was discharged after 5 days with an improvement of his blood urea nitrogen to 21 mg/dL and creatinine level of 2.1 mg/dL. Two days later, the patient sought emergent care for the new onset of respiratory symptoms, the return of diarrhea, and one episode of hematemesis. The patient lived on a farm with his parents and 2 siblings. He denied drinking alcohol, smoking tobacco, and taking illicit drugs.