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A 5-year-old boy with a history of autism spectrum disorder was seen in his pediatrician’s office approximately 3 weeks ago for a honey-crusted rash on his face, the dorsal aspect of his hands, and his legs. At that time, he was diagnosed as having impetigo and given a prescription for triple antibiotic cream to place on the skin lesions for the next 2 weeks. The lesions improved, but several weeks after the impetigo was diagnosed, the boy became less active and developed swelling of his eyelids, face, and hands. His condition culminated with notably decreased oral intake for a few days and the appearance of coffee-colored urine noted in the toilet, prompting the family to bring the boy to the local emergency department.

On examination, the child is not toxic appearing and does not engage the physician but will interact with...

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