A Diagnosis of Exclusion: A 3-Year-Old Boy With Respiratory Distress and Anemia

[摘要] Case: A 3-year-old boy presented to an outside hospital’s emergency department with 3 days of worsening nonproductive cough. At the outside hospital, he was found to be hypoxic with a chest radiograph demonstrating bilateral infiltrates. He was transferred to our children’s hospital with a presumed diagnosis of pneumonia.On admission to our hospital, the patient was afebrile, pale, and in mild respiratory distress. Review of systems revealed low-grade fevers for 3 days before admission but no weight loss, vomiting, hemoptysis, or sick contacts. Medical history revealed a previous diagnosis of iron-deficiency anemia, which had resolved with ferrous sulfate administration. Family history was positive for asthma. Initial oxygen saturation was 88%, which recovered to 95% on 2 L/min of oxygen by nasal cannula. His heart rate was 138 beats per minute, and his respiratory rate was 44 breaths per minute; his blood pressure was 101/66 mm Hg. The patient’s weight was 13.2 kg (10th–25th percentile), and his height was 91.5 cm (5th–10th percentile). On examination, pallor and subcostal and supraclavicular retractions were appreciated; auscultation of his lungs revealed slightly reduced breath sounds throughout, without wheeze or crackles. The rest of the physical examination was normal.The patient was continued on oxygen by nasal cannula and was started on intravenous fluids for poor oral intake secondary to respiratory effort. He was also given ceftriaxone as treatment for presumed community-acquired pneumonia (CAP).Question: What further evaluation is indicated in the case of presumed pneumonia in a patient presenting with hypoxia and respiratory distress? Discussion: According to 2011 Infectious Diseases Society of America guidelines for CAP, posteroanterior and lateral chest radiographs should be obtained in all patients who are admitted for CAP to document infiltrates and to screen for complications of pneumonia, including parapneumonic effusion, necrotizing pneumonia, and pneumothorax.1 The results of radiographs …

[学科分类] 儿科学

[关键词] Campylobacter;proljev;dob