DrVirgo
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A 12 year old boy presents with acute onset of morbiliform rash, fever, malaise, and oliguria. These manifestations began 1 week after starting treatment with ampicillin for streptococcal pharyngitis. His temperature is 38.8C (102F), BP is 115/76, pulse is 95/min. Resp are 16/min. Urinalysis shows microhematuria, leukocyturia with numerous eosinophils, and occasional white blood cell casts. Proteinuria is absent. Blood studies show elevated antistreptolysin titers adn moderate eosinophilia. BUN is 42 mg/dL, adn serum Creatinine is 2.5mg/dL. Which of the following is the most likely diagnosis?
A. Acute interstitial nephritis
B. Acute pyelonephritis
C. Acute tubular necrosis
D. Henoch-Schonlein purpura
E. Post-Steptococcal glomerulonephritis
A or E??? Please explain the difference.
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| Justice
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A or E?
Based on presentation, I would say they are superimposed... But still choose (A) to favor eosinophils in blood in urine
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| khorshid
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A ( no proteinuria, and the antibiotics have been started for the pt after all so it is not E, and then eosinophila in urine plus the rash to me points to interstitial nephritis).
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| ssrpk
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agree, don't fall into the indescent trap of elevated ASO, titers cause they are definitely gonna be high after strep infection. 
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| prathapdoctor
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its surely A only, you never see whiteblood cell casts in Glomerulonephritis and Red cell casts must always be there to diagnose it.
WBC casts,mircohematuria and increased esinophils, prior amoxycillin use point toward A only.
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| DrVirgo
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Thanks guys, you are right. Answer is A! 
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| CocaCola
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A
as said earlier - red cell cast should have been present for glomerulonephritis
Another factor that leads you away from post-strep glomerulonephritis, no HTN...
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