A
2-month-old infant with pneumonia
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Prepared
by...
Virat Sirisanthana, M.D.
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Department
of Pediatrics, Faculty of Medicine, Chiang Mai University
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| Chief
Complaint and Present Illness: A 2-month-old
male infant had a 7-day history of subacute onset of difficulty
in breathing, peripheral cyanosis and low grade fever.
He was born by vaginal delivery without any complication.
His birth weight was 3170 grams. When he was one month
old he had diarrhea and was treated as an outpstient.
Since then he has been well until this illness. |
| Family
History : was not available at the time of admission |
Physical
examination:
GA: BW: 3900 grams, was intubated, mild pale, no
jaundice
VS: T= 38.4 C (max), RR= 100/min, P = 160/min,
Anterior fontanelle 1.5 x 1.5 cm., not bulging
Chest: subcostal & intercostal retraction, Lung: clear
, no crepitation on auscultation
Abdomen: liver 6 cm below RCM , spleen 3 cm below LCM. |
Laboratory
Findings:
Complete blood count: Hemoglobin 10.7 g/dl, hematocrit
35 % , platelets 28,000, WBC 40,600, differential:
40 % polys (1% band), 57 % lymphocytes, 2% monocytes,
1% eosinophile,
Electrolyte: Na 131 , K 4.9 , Cl 100 , CO2 15 mEq/L,
BUN 11 mg% , Cr 0.3 mg%
Chest radiograph: (see below). |
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Click
to see larger CXR |
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| He
was intubated and specimen from modified bronchoalviolar
lavage was obtained. |
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Click
to see larger picture of the Wright stain of the specimen |
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Click
to see larger picture of the GMS stain of the specimen |
| What
is your diagnosis? |
| Further
course of illness......... Click
here |
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