Case Presentation
A 7-year-old Caucasian boy came to the pediatric emergency room with
symptoms of acute dyspnea. His parents reported that he was quite well
the previous day and that during the night he suddenly woke up with
shortness of breath. Apart from borderline growth on the
3rd centile, this was a healthy boy with no
significant past medical history (Figure 1a). On arrival, he was febrile
(38.1° C) and tachydyspnoeic, with a dry cough and marked tachycardia.
The unaided oxygen saturation of peripheral blood (SpO2) was 83%. On
physical examination, severe bronchial obstruction was detected,
therefore intensive bronchodilation therapy with short-acting β agonist
(SABA) was started and the boy was admitted to the inpatient department.
There, on oxygen therapy (3 liters/min via a face mask) his SpO2
normalized. The physician then ordered C-reactive protein (CRP), full
blood count (CBC), chest radiograph, and an antigen panel for common
respiratory viruses. The CRP was elevated (77.8 mg/L, reference range: 0
– 5 mg/l), the CBC showed marked leukocytosis with neutrophil
predominance (33.0 × 10⁹/L, reference range: 4.5 – 14.5 x
109). The chest radiograph (Figure 1b) revealed
bilateral pulmonary infiltrates, while the left middle and left lower
fields showed a nearly complete homogeneous reduction of translucency.
After obtaining the samples for microbiology cultures, antibiotic
treatment with ampicillin 300 mg/kg/day divided into three doses,
repeated bronchodilation therapy (salbutamol, 100 ug/dose) and
intravenous methylprednisolone for 5 days (1.1 mg/kg/day) were
administered.