19 year old male
presenting with fever, melena, worsening oliguria
with pallor, nausea, abdominal pain, agitation
Hemoglobin 90 --> 62
platelet 237 --> 22
WBC 30 (seg 53 lymp 35)
PBS: echinocytes, leukoerythroblastosis
prolonged PT and PTT
underwent emergency hemodialysis
rapid hepa screen: negative
post HD crea 1300
normal initial bilirubins
aminotransferases drastically shoot up
AST 130 --> 32000
ALT 40 --> 9000
chest xray: suggestive of pulmonary hypoplasia
kidney ultrasound: bilaterally small 5 cm and 6 cm
still no stool or blood culture result
underwent pRBC transfusion
developed rapidly decreasing sensorium
then eventually expired after ACLS
What is the most likely diagnosis and what are the plausible differentials?
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