[Solved]: A 13-year-old boy presented to the clinic…

A 13-year-old boy presented to the clinic complaining of a sore throat that persisted for 2 days. After those 2 days, he developed fever, nausea, and malaise. A throat culture revealed the presence of Group A beta hemolytic streptococci, and the child was started on antibiotic therapy. The child’s symptoms gradually improved, but approximately 2 weeks later, he returned to the clinic because the fever, nausea, and malaise returned. He became tachypneic and short of breath. The mother noted that his eyes were puffy, his ankles were swollen, and his urine was dark and cloudy. On examination, the child’s blood pressure was 148/100 mm Hg, his pulse was 122 beats/min, and his respirations were 35/min. Orbital and ankle edema were present. Rales (abnormal breath sounds) were auscultated bilaterally in the chest, but no heart murmurs were found. Slight tenderness to percussion over the flank areas was noted. A chest X-ray showed evidence of congestion and edema in the lungs. The patient’s hematocrit was 37% and his WBC was 11,200/mm3.