A 10 year old girl presents shortly after a tonic-clonic seizure. She had experienced low-grade fever for a week, a severe headache for 2 days and loss of vision since waking up today. Her medical, family and birth histories are unremarkable.
Urea: 40 mg/dl (normal < 50) S. Creatinine: 0.4 mg/dl (normal: 0.3-0.7) Na+: 140 mEq/l K+: 4.0 mEq/l Cl-: 98 mEq/l
Color: dark pH: 5.0 RBC: 40 - 50 / hpf Pus: 1 - 2 / hpf Albumin: 2+ RBC casts and granular casts noted
The CT scan of the brain shows symmetric occipital hypodense lesions with cerebral edema.
Serum ASOT: 300 IU/mL (normal < 200) Serum C3: 30 mg/dL (normal: 80 - 180)