Publication

Abstract : A 5-year-old boy from a farming family was brought to the emergency department with abdominal pain and vomiting for 3 days, dysentery for 2 days, and breathing difficulty and hematemesis for 1 day before admission. On evaluation, the child was diagnosed with multiorgan dysfunction syndrome (rapidly progressive kidney failure, hepatic dysfunction, and respiratory failure) requiring mechanical ventilation and continuous kidney replacement therapy. The child had no significant family history. However, the family noted that 2 calves had died in his household in the same week. Evaluation results for vasculitis, anti–glomerular basement membrane disease, lupus, and infectious etiologies, including malaria, dengue, leptospirosis, typhoid, brucella, and anthrax, were negative. Despite life support, the child succumbed after 2 weeks. After the patient’s death, his father revealed that the patient was noted to have blue-colored vomitus in the initial days of the illness (Figure 1). The father of the child had taken the image of the blue vomitus at home with his telephone. Thereafter, serum copper levels were tested on stored sera, which were 210 μg/dl (normal range, 70–150 μg/dl).