A 2-month-old infant with pneumonia

Prepared by...
Virat Sirisanthana, M.D.
Department of Pediatrics, Faculty of Medicine, Chiang Mai University
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).
Click to see larger CXR
He was intubated and specimen from modified bronchoalviolar lavage was obtained.
Click to see larger picture of the Wright stain of the specimen 
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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