Platelet disorders Quiz: Ace Your Exams

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A 7-year-old boy is brought to the emergency department by his parent due to 3 days of fatigue, malaise, decreased urine output, and gingival bleeding. The parent states that the patient had abdominal pain and bloody diarrhea one week earlier, which resolved without treatment. The patient has no prior medical diagnoses. Family history is also non-contributory. Temperature is 37.0°C (98.6° F), pulse is 94/min, respirations are 22/min, and blood pressure is 106/68. Physical exam shows petechiae on the arms and in the mouth. Laboratory testing and urinalysis are obtained and shown below.  
 
Laboratory value Result 
 Hematologic  
 Platelet count  45,000/mm3  
 Hemoglobin  9.4 g/dL 
 Reticulocyte count   4.1% 
 Haptoglobin  9 mg/dL 
Blood, plasma, serum  
 Total bilirubin  5 mg/dL 
 Direct bilirubin  0.3 mg/dL 
 Creatinine  2.3 mg/dL 
 Blood Urea Nitrogen (BUN)  32 mg/dL 
 Lactate dehydrogenase (LDH)  370 U/L 
 Urine  
 Color  Pink 
 Casts   RBC casts 
Which of the following toxins is produced by the causative organism?

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