PRESENTING FELLOWSharon Dell, Paediatric Respiratory Resident
Hospital for Sick Children, Toronto, Ontario
REASON FOR REFERRALA 2 year old Canadian girl of East Indian ethnicity presented with a three day history of fever, cough and nasal congestion. She was tachypneic and had a small oxygen requirement. A CXR showed a "ground glass" appearance on the right side and an overall interstitial pattern.
Of note, she had been unwell for the previous two months. She had been admitted to hospital for 3 weeks at the beginning of this illness with a diagnosis of "Atypical Kawasaki Disease". This had manifested as a flu like illness with prolonged fever, rash and a mild myocarditis.
She was treated with several courses of IVIG with no clinical response. Finally she was treated with steroids, with some clinical response, and discharged home on 2mg/kg of Prednisone, which she had now been on for over a month. A chest consult was called, to give an opinion on the etiology of her current lung disease.
PLEASE VIEW THE CURRENT CHEST XR (MAY 22) BEFORE YOU GET MORE HISTORY AND REFINE YOUR DIFFERENTIAL DIAGNOSIS.
ENLARGE the XR
This 2 year old girl presented two months ago (end of winter) with a flu-like illness which consisted of fever for 2 weeks, puffy eyes, hands and feet and an erythematous, "slapped cheek" appearing face. She was diagnosed with pneumonia at a community hospital after a CXR apparently showed right lower lobe and left lower lobe infiltrates. She was treated with Cefzil followed by Zithromax and had no clinical response. A cursory infectious work-up with nasopharyngeal swab and blood cultures was negative. A diagnosis of Kawasaki disease was made and she was treated with intravenous immunoglobulins and ASA at the community hospital. She still did not defervesce.