A 7 month old presenting with respiratory distress
2004
A 5 month old south Asian male presented to his general practitioner (GP) with a history of recurrent wheeze and noisy breathing of 2 months duration. He had been born at term and his growth and development were normal. There were no significant medical problems in the family, apart from his grandmother's hypothyroidism. He was diagnosed by his GP to have viral wheeze and was started on inhaled salbutamol via a metered dose inhaler plus spacer with no apparent benefit. At this stage, a chest radiograph did not show any abnormality. At 6 months old, the patient was admitted to the local hospital with a history of cough, respiratory distress and stridor, which improved after receiving oral dexamethasone for 2 days.
At 7 months old, he presented at the current authors' hospital with a 2‐day history of cough, wheeze and breathlessness. On examination, the patient was afebrile with moderate respiratory distress and had widespread crepitations and rhonchi. Otherwise, clinical examination was normal. A clinical diagnosis of acute bronchiolitis was made. He needed supplemental oxygen to maintain normal oxygen saturations and was also given a trial of nebulised salbutamol with no apparent benefit.
He was noted to have intermittent noisy breathing, although no obvious upper airway obstructive pathology could be identified. He was making a very slow, but gradual, recovery; however, on day 8, there was clinical deterioration with worsening cough, breathlessness, and noisy breathing. He was found to be tachypnoeic with subcostal and intercostal recession, but his chest was clinically clear on auscultation.
The chest radiograph (fig. 1⇓) showed significant radiological changes compared to the chest radiograph taken at 5 months old.
Fig. 1.—
Chest radiograph of the patient.
The patient was extensively investigated. Table 1⇓ shows a summary of the investigations performed.
View this table:
Table 1—
Summary of investigations
Biopsies were …
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