Difficulty breathing in a 4-month-old infant

Prepared by...
Virat Sirisanthana, M.D.
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).
Chest radiograph: day 1 and day 3
2-CXR-d1-1Terapas-4m.jpg (40679 bytes)
3-CXR-d3-3Terapas-4m.jpg (34636 bytes)
Modified bronchoalveolar larvage
BAL-trophozoite-1000X-3.jpg (41623 bytes)
Giemsa stain   1000X

Lung histopatology ( with the curtesy of Dr. Amnart Yousukh, Department of Pathology)

Giemsa-X100.jpg (53310 bytes)
Giemsa stain : 1000X
H+E-X100.jpg (61259 bytes)
H+E stain : 1000X
pas-x100.jpg (58421 bytes)
H+E stain : 1000X
pas-x100.jpg (58421 bytes)
PAS stain : 1000X
gms-x100.jpg (57513 bytes)
GMS stain : 1000X

Final Diagnosis: Pneumocystis carinii pneumonia in HIV-infected infant

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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