Diagnostic Dilemma

Pneumonia in a 4 month old

Author: Pediatric Oncall
A 4-month-old boy presented with fever, cough, cold for 5 days and breathlessness for 1 day with decreased appetite. He was a full term normal delivery without antenatal or postnatal complications on bottle feeds with cow’s milk. He was immunized for his age. On examination, he had respiratory rate of 58/min with intercostals, substernal retractions and was febrile. There were bronchial breath sounds on right infrascapular region. Other systems were normal. Investigations showed:
• Hemoglobin = 10.2 gm/dl
• WBC count = 30,800/cumm [58% polymorphs, 42% lymphocytes]
• Platelet count = 6,75,000/cumm
• Arterial blood gas = pH = 7.39, PCO2 = 35, mm PO2 = 61, mm of Hg, bicarbonate = 21 mEq/L and oxygen saturation of 91%.
• ESR = 115 mm at end of 1 hour
• Chest X-Ray = Bilateral lower zone pneumonia with minimal pleural effusion and inter fissural effusion on right side.

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