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125270 Pathology

An 8-year-old boy presents with headaches, dizziness, and malaise approximately 2 weeks after a severe sore throat. His mother describes puffiness of his face and darkening of his urine. She also notes that her son is passing less urine and that he is becoming increasingly short of breath. On physical examination, there is anasarca, hypertension (190/130 mm Hg), and tachycardia. The urine is scanty and brownish red. Urinalysis shows 3+ proteinuria. Microscopic examination of the urine discloses numerous RBCs, as well as occasional granular and red cell casts. A renal biopsy is stained by direct immunofluorescence microscopy for complement C3, and the results are shown. Which of the following is the most likely cause of acute postinfectious glomerulonephritis in the patient?

AEscherichia coli
BEpstein-Barr virus
CGroup A (b-hemolytic) streptococci
DKlebsiella sp.
Pathology
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