case5

Difficulty breathing in a 4-month-old infant (Page 1/2)

Prepared by... Virat Sirisanthana, M.D.
Department of Pediatrics, Chiang Mai University




A 4-month-old previously healthy male infant had a 3-day history of acute onset of difficulty in breathing. On physical eaminition he was in severe respiratory distress, so he was intubated and was on respirator. Other significant PE included BW 4.5 kg, pale, liver 5 cm below RCM, spleen 3 cm below LCM, generalized lymphadenopathy. Two days later he expired.
Family History:
	was not available.
Laboratory :
	Complete blood count: Hemoglobin: 3.6 g/dl, hematocrit: 13 % , platelets: 126,000 WBC: 23,500 Differential: 23 % polys (5%band), 77 % lymphocytes. CSF: examination WNL
	Serology : HIV-Ab : positive
	Serum Enzymes: Lactate dehydrogenase: 3,983 units/L
	Blood culture : no growth for bacteria and fungus
	*Chest radiograph:* (see below).

Chest radiograph: day 1 and day 3


Modified bronchoalveolar larvage
	Giemsa stain 1000X


Lung histopatology ( with the curtesy of Dr. Amnart Yousukh, Department of Pathology)
	Giemsa stain : 1000X

	H+E stain : 1000X

	PAS stain : 1000X

	GMS stain : 1000X

Final Diagnosis: Pneumocystis carinii pneumonia in HIV-infected infant

Discussion : The anemia in this case (hemoglobin: 3.6 g/dl, hematocrit: 13 %) is not typical for Pneumocystis carinii pneumonia. The cause of anemia was not fully studied, since the patients expired in 2 days after admission.