Donald J. Kovacs, MD

Ten days after ballet practice, a 9-year-old girl noticed a nonpruritic, petechial rash on her lower legs. Swelling of the ankles and knees was also apparent. The patient was afebrile, otherwise healthy, and had no abdominal pain. There was no family history of blood dyscrasias. The patient was taking no medications.

For 1 week, a 22-month-old boy experienced gradually increasing facial swelling followed by swelling of the abdomen and legs. His mother reported that the child's urinary output had markedly decreased. During this period, the youngster gained 5 lb.

Proximal bilateral upper extremity weakness had slowly progressed in a 34-year-old woman until she could no longer raise her arms above her shoulders. She first noticed the weakness at age 18; previously, she had been active in sports and her development had been normal.

A 34-year-old woman presented with a3-day history of painful blisters of theupper lip and nose. Five days earlier,a rapid antigen test had confirmedstreptococcal pharyngitis; amoxicillinwas prescribed. The patient had nohistory of herpes and was immunocompetent.She had several youngchildren and did not work outsidethe home.