Coagulation disorders Quiz: Ace Your Exams

A 3-week-old boy presents to the emergency department due to worsening vomiting at home. The vomiting began suddenly today, and the patient has been more sleepy than usual. He was born full-term at home to a mother who has a history of epilepsy but is otherwise healthy. The patient has not received any vaccines since the mother is concerned they will increase his risk of developing “behavioral disorders.” Temperature is 37.0°C (98.6°F), pulse is 190/min, respirations are 52/min, and blood pressure is 104/54 mmHg. On physical examination the infant begins seizing with tonic-clonic movements in the upper and lower extremities. He is noted to have a bulging anterior fontanelle and downward displacement of the eyes. No pain is elicited with flexion of the neck. Point of care glucose is 60 mg/dL. Which of the following best describes the etiology of this patient’s clinical presentation?