A previously healthy, 18-month-old girl was admitted to a local hospital after four days of fever. On physical examination, no bleeding tendency or circulatory failure was noted. There was no history of previous renal disease. Laboratory data were as follows: hemoglobin, 11.2 g/dl; platelet count, 200,000/cu mm; and BUN, 30 mg/dl. The systolic blood pressure was 90 mm Hg. Normal CSF was obtained. Bacteriological cultures from specimens of blood, middle ear secretions, and throat grew pneumococci. Treatment with intravenous fluids and antibiotics (ampicillin sodium and a single dose of kanamycin sulfate) was immediately started. Twenty-four hours after admission, the patient had generalized seizures of short duration.
On the second day after admission, she was transferred to the Department of Pediatrics, University Hospital of Lund, Lund, Sweden, because of increasing BUN (120 mg/dl), decreasing platelet count (36,000/cu mm), and oliguria. The physical examination at that time showed peripheral edema but no