Haematuria during methicillin therapy.

Case report A 15-year-old boy (P.S. 110521) with a ventricular septal defect was admitted as an emergency 6 days after falling and bruising his knee. After this he had gradually developed an increasing pyrexia, tachycadia and loose stools. He denied dental treatment within the last 6 months. A ventricular septal defect had been diagnosed clinically at the age of 1 year and was shown by catheterization at the age of 7 years to be small (left to right shunt of 0-8 I/min; Dr H. A. Flemming). He had never had effort intolerance. On admission he had a non-productive cough, pleuritic pain bilaterally, increasing dypsnoea and generalized abdominal pain. He was confused. On examination his temperature was 103 6°F (39 8°C), his pulse 120, regular and blood pressure 100/80 mmHg. He had the characteristic signs of a ventrical septal defect but no specific clinical signs of septicaemia. He was grossly dyspnoeic with shallow grunting respiration at a rate of 46/min. He had generalized abdominal tenderness. There were no abnormalities in the teeth of gums and both knees were normal on examination. Investigations. On admission, haemoglobin 12-5