Case Report

A 20-year-old male with no significant past medical history presented to an outside hospital with a two-week history of progressive fatigue, malaise and decreased appetite. Prior to these events, he had been in his usual state of health with normal exercise tolerance and energy level. Upon development of his symptoms, the patient felt as though he had developed an upper respiratory infection (URI). The URI symptoms eventually resolved; however complaints of fatigue and malaise still remained. He then developed progressive dyspnea on exertion and tea-colored urine. The patient reported a singular febrile episode to 38.9˚C associated with nonbilious vomiting two days prior to admission. Upon further questioning, he admitted to a twenty-pound weight loss over the last month. The patient’s mother also noticed unprovoked bruising on his forearms bilaterally. He denied night sweats, gingival bleeding, epistaxis, hematuria, or melena.