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Difficulty
breathing in a 4-month-old infant
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Prepared
by...
Virat Sirisanthana, M.D.
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| Department
of Pediatrics, Faculty of Medicine, Chiang Mai University |
| A
4-month-old previously healthy male infant had a 3-day
history of acute onset of difficulty in breathing. On
physical eaminition he was in severe respiratory distress,
so he was intubated and was on respirator. Other
significant PE included BW 4.5 kg, pale, liver 5
cm below RCM, spleen 3 cm below LCM, generalized lymphadenopathy.
Two days later he expired. |
Family
History : was not available.
Laboratory :Complete blood count: Hemoglobin:
3.6 g/dl, hematocrit: 13 % , platelets: 126,000
WBC: 23,500 Differential: 23 % polys (5%band), 77
% lymphocytes.
CSF: examination WNL
Serology : HIV-Ab : positive
Serum Enzymes: Lactate dehydrogenase: 3,983
units/L
Blood culture : no growth for bacteria and
fungus
Chest radiograph: (see below). |
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Chest
radiograph: day 1 and day 3
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Modified
bronchoalveolar larvage
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Giemsa
stain 1000X |
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Lung
histopatology ( with the curtesy of Dr. Amnart Yousukh,
Department of Pathology)
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Giemsa
stain : 1000X |
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H+E
stain : 1000X |
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H+E
stain : 1000X |
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PAS
stain : 1000X |
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GMS
stain : 1000X |
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Final
Diagnosis: Pneumocystis carinii pneumonia in
HIV-infected infant
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| Discussion
: The anemia in this case (hemoglobin: 3.6 g/dl,
hematocrit: 13 %) is not typical for Pneumocystis
carinii pneumonia. The cause of anemia was not fully
studied, since the patients expired in 2 days after admission. |
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