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By 11 p.m. he was admitted to the emergency room of a district hospital. He was conscious, with normal breathing, dehydrated, hypotensive (BP 98/53 mmHg), mildly tachycardic (PR 96 ppm) and febrile (axillary temperature 37.8��C). The remaining cardiopulmonary and abdominal examination was normal. He had no signs of Murphy's kidney. Blood screening revealed neutrophil leukocytosis (27 300 leukocytes/?L; 24 800 neutrophils/?L), moderate azotemia [serum creatinine (SCr) 224 ?mol/L (59�C104); urea (Ur) 8.1 mmol/L (2.8�C7.2)] with normal electrolytes, high lactate dehydrogenase [LDH, 339 U/L (100�C247)] and creatine kinase [CK, 1580 U/L (10�C171)]. Urinalysis showed proteinuria (4+), glycosuria (2+), leukocyturia (75/?L) and haematuria (3+). Renal ultrasound was unremarkable. He received saline infusion (NaCl 0.9% 166 mL/h), empiric Ruxolitinib concentration antibiotic (IV ciprofloxacin 200 mg 12/12 h), antipyretic, antiemetic and antacid treatment. Twenty-four hours later his BP was normalized, but despite the sustained urine output (?100 mL/h), worsening azotaemia (SCr 430 ?mol/L, Ur 18.7 mmol/L) led to transferring him to our nephrology unit. He was doing well, but complained of dysuria and haematuria. Our laboratory work-up confirmed the earlier findings, along with thrombocytopaenia (88 000/?L), elevated serum C-reactive protein [74 mg/L Vemurafenib supplier ( data). Therefore, we asked for serology tests and changed the antibiotherapy to IV ceftriaxone, maintaining previous intensive parenteral fluid administration. During the subsequent days, we observed polyuria, resolution of haematuria (second day), with a progressive improvement of renal function. Leptospirosis serology and microbiological analysis of blood and urine were negative; immunological screening was also normal. Seven days later, at the time of discharge, he was asymptomatic; renal function had recovered, as well as other laboratory parameters. This complete recovery was confirmed in a re-evaluation Amiloride 15 days later. Discussion This case illustrates a clinical presentation of cantharidin toxicity resulting from ingestion of a blister beetle. The cantharidin content of one beetle ranges from 0.2 mg to 0.7 mg depending on the species [1]. The lethal dose in adults has been estimated to be from 10 to 80 mg, but most commonly is reported to be