Laboratory
WBC: 12,400 Differential: 40 % polys, 54 % lymphocytes, 5 % monocytes, 1% eosinophils,
RBC morphology: normochromic normocytic
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Prepared by...
Virat Sirisanthana, M.D. |
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Department of Pediatrics,
Chiang Mai University
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Chief Complaint: Difficulty
breathing
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History of Present Illness
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| A 3-month-old girl had a 1-week history of progressive difficulty in breathing. Her mother reports that her child has turned "dark" while sucking breast milk for the last three days. Today although she is restless, there has been no reduction in oral intake. The mother is not aware of any fever. | ||
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Past Medical History
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| The patient
was born at Maternal-child hospital in Chiang Mai. Her birth weight was
3000 kg. Her mother had history of positive VDRL at the first trimester,
which was treated with penicillin injection. The patient's birth history was uneventful. After birth she has been well until this admission. |
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Immunization History
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| She received the routine vaccinations (BCG at birth, DPT and OPV at 2 -month-old). | ||
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Family History
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| She is the only child. The patient’s parents are healthy. | ||
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Physical Examination
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| The patient is in moderate respiratory distress. BW 5 kg. | ||
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Vital Signs
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| Temperature:37.8
C Pulse: 158 beats per minute Respiration: 72 per minute
Blood Pressure 75/40 mmHg |
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HEENT
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| No evidence of rhinitis, otitis, or conjunctivitis. Oropharynx appears normal. | ||
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Chest
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| Moderate intercostal retractions, no wheeze. Air exchange is fair. | ||
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Cardiovascular
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| Good perfusion. Normal heart sounds without murmur | ||
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Abdomen
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| Liver 5 cm below RCM. Spleen 3 cm below LCM. | ||
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Genitourinary System
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| Normal | ||
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Extremities
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| Moderate cyanosis, no clubbing | ||
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Skin
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| Normal | ||
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Nervous System
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| Normal | ||
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Laboratory
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| Blood gas (room air) : hypoxia (O2 saturation =59%) with normocapnia | |
| Chest radiograph: (see below). | |
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| Figure 1
shows radiographs taken at the time of admission. The radiograph demonstrates
bilaterally increased interstitial markings Complete blood count:
Hemoglobin: 10 g/dl, hematocrit: 34 % , platelets: 88,500 WBC: 12,400 Differential: 40 % polys, 54 % lymphocytes, 5 % monocytes, 1% eosinophils, RBC morphology: normochromic normocytic |
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| Serology : HIV-Ab : positive | |
| Serum Enzymes: Lactate dehydrogenase: 709 units/L | |
| Blood culture : sent | |
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Questions
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| 1.Which of the following is the most likely diagnosis? | |
| A. Opportunistic
pneumonia, particularly Pneumocystis carinii or cytomegalovirus (CMV)
B. Pneumococcal pneumonia C. Asthmatic exacerbation s D. Foreign body aspiration E. Viral respiratory infection |
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| 2.Which of the following is the SECOND most likely diagnosis? | |
| A. Opportunistic
pneumonia, particularly Pneumocystis carinii or cytomegalovirus (CMV)
B. Pneumococcal pneumonia C. Asthmatic exacerbation D. Foreign body aspiration E. Viral respiratory infection |
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