PRESENTING FELLOWManisha B. Witmans
Pediatric Pulmonary Fellow, Alberta Children's Hospital
Calgary, Alberta, Canada
CASE PRESENTATIONA 22 month old Caucasian female from Alberta presented with a history of wheeze for 10 days in December 2000. The wheeze was noted in the morning and increased with activity. She had mild upper respiratory tract infection symptoms (rhinorrhea, cough) two weeks prior to presentation, which had cleared completely.
The infant was seen by a pediatrician and had a trial of inhaled fluticasone and salbutamol with no response. There is no history of aspiration and she had no constitutional symptoms.
Her past history revealed that she had one previous episode of wheeze that was diagnosed as bronchiolitis at 10 months of age. The prenatal course was complicated by placenta previa. Her mother was given dexamethasone at 32-33 weeks gestation. The infant was born at 35 weeks gestation. She was ventilated for 3 days during which time she received one dose of surfactant. She required oxygen therapy for an additional 3 weeks. There is no history of allergies and her immunizations are up to date.
Her family history revealed that mom has mild asthma and the maternal grandfather has eczema. There are no pets, no smokers, and no foreign travel. Additional history obtained later during her hospitalization revealed that her maternal grandfather had a chronic cough with hemoptysis and was diagnosed as "bronchitis".
She was referred to the asthma clinic to see a respirologist, but presented sooner because of persistent symptoms, lack of improvement with inhaled corticosteroids and an abnormal x-ray.