A boy with recurrent pneumonia

Abstract

A 6-yr-old boy was admitted to the paediatric department of the University of Heraklion (Heraklion, Greece) with fever (38.5uC), respiratory distress and had been coughing for 2 days. He was well prior to admission.His past medical history was remarkable for frequent episodes of bronchiolitis and bronchitis from age 7 months until 3 yrs, followed by one episode of bronchitis per year, thereafter. In the second day of life, he was hospitalised for tachypnoea, attributed to laryngomalacia. He was full-term, born by caesarean section, due to decreased heart sounds. His neonatal history was negative. He is the oldest of four healthy siblings. His family history is negative.On physical examination, the boy was slightly pale, had tachypnoea and respiratory distress. He was well-developed and nourished. His temperature was 37uC, respiratory rate was 28 breaths?min -1 , pulse was 117 beats?min -1 and O 2 saturation was 87%. Chest auscultation revealed decreased breath sounds and crackles over the right lower hemi-thorax. His cardiac sounds S 1 and S 2 were normal. His throat was slightly congested. The rest of his physical examination was normal.His chest radiography (CXR) is shown in fig. 1.