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Page 7/Case04/01

Other Comments/Discussion Raised during the Presentation of the Case

– Is there a need to repeat the chest x-ray after 2 months? Clinically, the infant was doing well therefore this was not done.

– How great is the concern regarding risk of complete endo-bronchial obstruction given the compression of the left mainstem, especially in the context of enlargement of nodes initially with therapy? The patient tolerated prednisone well and did not have a worsening of the wheeze or evidence of complete obstruction clinically.

– Some concerns were raised about the need for aggressive surgical management given the risk of complete bronchial obstruction, but the overall consensus was to adopt the present medical approach.

– Concerns were also raised about using ciprofloxacin for an extended period of time, as this has not been well studied. The decision was made by the respirology and infectious disease service to treat with these medications, as there was concern about suboptimal sensitivities with clarithromycin alone. Her growth has been monitored through the duration and she has had no side effects from these medications. This regimen has been reported with good outcome in adult disease.

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