CASE 1 | HISTORY
A 6-month-old boy with 1-week history of dry cough that worsened at night. He had been wheezing off and on for the past month and had visited the emergency department on one occasion. He had also vomited 4 times in the past 24 hours but had been drinking and eating well. He had no fever. His 2-year-old sister was also sick with cough and diarrhea. Infant lived with an aunt who smoked.
Birth history included mild neonatal jaundice that resolved and a small ventricular septal defect and patent foramen ovale that have been monitored by cardiology.
Temperature was 36.5ºC (97.7ºF); heart rate, 120 beats per minute; respiration rate, 40 breaths per minute with moderate distress; capillary oxygen saturation, 97% on room air. Length at the 10th percentile, weight between the 10th and 25th percentile. Eyes, tympanic membranes, and pharynx normal. Mucous membranes moist and tears present. Chest examination demonstrated subcostal and intercostal retractions. Auscultation revealed good air exchange bilaterally with no rales, but with diffuse wheezing and a grade 2 early systolic ejection murmur over the precordium. Rapid respiratory syncytial virus (RSV) test results negative.
CASE 2 | HISTORY
A 2-year-old girl with severe nighttime cough, congestion, and fever (temperature up to 39.5ºC [103ºF]) for the past 2 days. She had recently recovered from a respiratory tract illness of 1 month’s duration. She had been treated with nebulized albuterol, oral prednisolone(Drug information on prednisolone), and azithromycin(Drug information on azithromycin). Mother was frustrated because of the child’s persistent illness. Child also had occasional cough with exertion and lived with her parents who claimed to smoke outside the house.
Temperature was 38.9ºC (102.1ºF); heart rate, 95 beats per minute; respiration rate, 38 breaths per minute with considerable distress; capillary oxygen saturation, 87% to 89% on room air. Growth parameters normal. Chest examination demonstrated suprasternal, intercostal, and subcostal retractions with diffuse wheezing and rhonchi. Rapid RSV and influenza test results negative.
Posteroanterior chest radiographs of both patients are shown.
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