CASE REPORT
A 3-yr-old female presented at the emergency dept with a 24-h history of dyspnoea, productive cough, bilious vomiting and a low-grade fever. At physical examination, nasal flaring and mild chest retractions were noted. No stridor or wheezing was present and oxygen saturation was normal. Heart rate was 120 bpm in the presence of a low-grade fever (38.6°C). Decreased breath sounds were heard over the right hemithorax, while no asymmetry was noted on either chest inspection or percussion. Otherwise, the findings of physical examination were normal.
Laboratory investigation showed no signs of infection. A chest radiograph was performed (fig. 1⇓). As a result of the dyspnoea, the patient was admitted and azithromycin was commenced to cover possible Mycoplasma pneumoniae. However, serological screening for Mycoplasma antibodies was negative. Furthermore, no pathogen was cultured from either blood or pharynx.
During admission an additional history was taken, in which the mother reported that the child had previously choked upon eating a piece of candy, 1 week before the onset of symptoms. To rule out the presence of a foreign body, which could explain both the symptoms and the abnormalities seen on chest radiography, the patient was transferred to a tertiary centre for bronchoscopic evaluation. At bronchoscopy, purulent sputum was noted in the left main bronchus but no foreign body was found. Laboratory investigation was repeated, showing C-reactive protein (CRP) of 16 mg·L−1 without any other abnormalities. Moraxella catarrhalis was cultured from the sputum obtained at bronchoscopy. This pathogen was treated with amoxicillin and clavulanic acid for 7 days, although no clear signs of infection were demonstrated. As no explanation for the clinical situation was found, computed tomography (CT) of the chest was performed 5 days after admission (fig. 2⇓).
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