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+A 35-year-old woman presented to the medical emergency department with low-grade fever for 3 weeks, vomiting for 1 week and anuria for 3 days.
+She also reported dysuria and breathlessness for 1 week.
+There was no history of decreased urine output, dialysis, effort intolerance, chest pain or palpitation, dyspnoea and weight loss.
+Menstrual history was within normal limit but she reported gradually progressive loss of appetite.
+Family history included smoky urine in her younger brother in his childhood, who died in an accident.
+On general survey, the patient was conscious and alert.
+She was dyspnoeic and febrile.
+Severe pallor was present with mild pedal oedema.
+Blood pressure was 180/100 mm Hg and pulse rate of 116/min regular.
+No evidence of jaundice, clubbing cyanosis or lymphadenopathy was found.
+Physical examination revealed bibasilar end-inspiratory crepitations in lungs and suprapubic tenderness.
+There was no hepatosplenomegaly or ascites.
+Cardiac examination was normal.
+She was found to have severe bilateral hearing loss, which was gradually progressive for 5 years.
+The fundi were bilaterally pale.
+The patient was referred to the department of ophthalmology for a comprehensive eye examination.
+Her visual acuity was documented as 6/18 in both eyes with no obvious lenticular opacity.
+Slit-lamp examination showed bilateral anterior lentiglobus (figure 1) with posterior lenticonus (figure 2).
+Distant direct ophthalmoscopy revealed oil droplet sign (a suggestive confirmation of the presence of lenticonus); and peripheral retina revealed multiple yellowish white lesion-like flecks in the mid-periphery, and few blot haemorrhages indicative of hypertensive changes (figures 3 and ​4).