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Chest clinic
Case based discussion
An adolescent with persistent cough, abdominal pain and refusal to walk from Salesi Children's Hospital
  1. Silvia Angeloni1,
  2. Ines Carloni1,
  3. Patrizia Osimani1,
  4. Lucia Amici2,
  5. Cecilia Lanza2,
  6. Fernando Maria de Benedictis1
  1. 1Department of Mother and Child Health, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
  2. 2Department of Radiological Sciences, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
  1. Correspondence to Professor Fernando Maria de Benedictis, Division of Pediatrics, Salesi Children's Hospital, 11, via Corridoni, Ancona I-60123, Italy; debenedictis{at}ospedaliriuniti.marche.it

https://doi.org/10.1136/thoraxjnl-2014-205965

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    SA (resident)

    A 12-year-old boy was admitted to our unit for a 3-day history of abdominal and right groin pain, refusal to walk and relapse of fever. His clinical history was uneventful until 2 weeks before, when he developed acute onset of fever, cough and breathlessness. Right upper lobe pneumonia was diagnosed by chest X-ray and intramuscular ceftriaxone treatment was administered for 10 days followed by fever reduction after 3-day therapy. On admission, he appeared quite unwell with fever and wet cough. He was moderately tachycardic and tachypnoeic with oxygen saturations of 94% in air. Chest examination revealed dullness to percussion and reduced breath sound over the upper right lung field with a few crackles. Abdomen was diffusely painful and tender to palpation in the left upper quadrant. Mild splenomegaly was also evident. The proximal portion of the right thigh appeared moderately swollen and warm, with no skin colour changes. Laboratory investigation revealed 23 000/mm3 white blood cells (77% neutrophils), with normal platelet count and haemoglobin level. Erythrocyte sedimentation rate and C reactive protein were 48 mm/h and 7.4 mg/dL (<0.5), respectively. Liver and renal function tests were normal. Repeated chest X-rays revealed right upper lobe consolidation.

    FMdB (senior clinician)

    We have a previously healthy young boy with persistence of clinical and radiological findings of pneumonia who developed non-respiratory symptoms over the last few days. Correct drug administration, antibiotic resistance, aggravating or underlying conditions, complicated pneumonia and aetiological agents unresponsive to treatment should be taken into account in similar cases. Streptococcus pneumoniae is the most common bacterial cause of community-acquired pneumonia in childhood. Although amoxicillin is recommended as first choice drug for antibiotic therapy, administration of cephalosporins may represent an alternative.1 The patient received correct ceftriaxone dosage, the duration of treatment was adequate, and pneumococcal β-lactam non-susceptibility is rare in Italy. The personal history was not suggestive of …

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    Footnotes

    • Contributors SA treated the patient initially and contributed to the manuscript. IC treated the patient and conceived the manuscript. PO treated the patient and contributed to the interpretation of laboratory data. LA performed all radiological images and contributed to the radiological aspects of discussion. CL contributed to the imaging interpretation and discussion. FMdB supervised the treatment of the patient, contributed to the clinical aspects of discussion and critically reviewed the manuscript.

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; internally peer reviewed.