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.