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Case based discussion
Acute haemoptysis, fever and abdominal pain in an adolescent from northern Australia
  1. Daniel K Yeoh1,2,
  2. Timothy J Ford1,3,
  3. Joanna Chua4,
  4. Miriam Bennamoun3,
  5. Christopher C Blyth1,3,4,5,
  6. Anita J Campbell1,3,5,
  7. Prasanthy Hamsanathan6,
  8. Ben Harkin7,
  9. Jovanka King8,
  10. Lisa Matthews3,
  11. Charlie McLeod1,5,
  12. Rebecca Warren9,
  13. Asha C Bowen1,3,5,
  14. Melanie J Thompson3,7,
  15. André Schultz3,10,11
  1. 1 Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
  2. 2 Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
  3. 3 Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
  4. 4 Department of Microbiology, PathWest Laboratory Medicine Western Australia, Nedlands, Western Australia, Australia
  5. 5 Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
  6. 6 Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
  7. 7 Department of Paediatrics and Child Health, Kimberley Region, Western Australia Country Health Service, Broome, Western Australia, Australia
  8. 8 Department of Allergy and Clinical Immunology, Women's and Children's Hospital, Adelaide, South Australia, Australia
  9. 9 Royal Flying Doctor Service of Australia, Broome, Western Australia, Australia
  10. 10 Department of Respiratory Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
  11. 11 Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
  1. Correspondence to Dr Daniel K Yeoh, Infectious Diseases, Perth Children's Hospital, Nedlands, WA 6009, Australia; daniel.yeoh{at}health.wa.gov.au

http://dx.doi.org/10.1136/thoraxjnl-2020-216257

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    BH (registrar, Broome Regional Hospital)

    Our team was referred a 14-year-old, previously healthy, immunised aboriginal boy from a remote community in northern Western Australia. He had been admitted to the local community hospital 10 days previously and while there developed haemoptysis, fever and epigastric abdominal pain so was transferred to our care at the regional hospital for ongoing investigation and management.

    AS (respiratory consultant, Perth Children’s Hospital) and MJT (paediatrician, Broome)

    Haemoptysis is an uncommon presentation in adolescence. It can be caused by infection (eg, bronchiectasis, pneumonia, lung abscess or tuberculosis), trauma (eg, lung contusion, foreign body or inhalation injury), vascular disorders (eg, pulmonary embolus, arteriovenous malformation or haemangioma), late complications of congenital lung malformations, coagulopathy or one of the diffuse alveolar haemorrhage syndromes.1 Additionally, bleeding from the upper airway or gastrointestinal tract can mimic haemoptysis.

    Demographic considerations are important in this case. Bronchiectasis and rheumatic heart disease, both of which may present with haemoptysis, have increased prevalence in aboriginal children in Australia. In addition, Burkholderia pseudomallei is endemic and pulmonary infection can mimic tuberculosis.

    An infectious aetiology is favoured here in view of the history of fever.

    BH (registrar, Broome)

    He had initially been admitted to the local hospital with presumed bacterial meningitis following presentation with headache, fever and meningism 10 days prior. Cerebrospinal fluid (CSF) prior to antibiotics demonstrated elevated white cell count (WCC) 550/mm3 (90% neutrophils) and protein (0.84 g/L), with negative microscopy and culture for bacteria, and negative PCR testing for bacteria and viruses. Intravenous ceftriaxone (ongoing) and dexamethasone 0.15 mg/kg four times a day (total 4 days) had been administered, with rapid resolution of symptoms.

    Following transfer to our care (day 1), examination showed normal respiratory rate and oxygen saturations (SaO2=98%); a productive cough with a moderate amount of blood-stained sputum was noted. The respiratory examination (including upper airway) was otherwise unremarkable. There was mild right upper quadrant abdominal tenderness …

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    Footnotes

    • Twitter @_charliemcleod

    • Contributors CM, MJT, TJF, AS and DKY contributed to conception of the work. MB, LM, CM, TJF, AS, JC and DKY contributed to drafting the article. All authors contributed to critical revision of the article. All authors have provided final approval of the version to be published.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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