Occult pneumonia in a child

We describe the case of a 10-year-old boy who presented with high fever, vomiting and diarrhoea. There were no respiratory symptoms and auscultation and percussion of the lungs were normal. The combination of the clinical picture with a high C reactive protein value prompted us to perform a diagnost...

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Bibliographic Details
Published in:BMJ case reports 2012-06, Vol.2012 (jun07 1), p.bcr0120125521-bcr0120125521
Main Authors: Ploegstra, Wieteke M, Onnes, Bettine, de Vries, Nathalie K S, Kamps, Arvid W A
Format: Article
Language:English
Subjects:
Abdomen
Abscesses
Anti-Bacterial Agents - therapeutic use
Antibiotics
Auscultation
Blood
Child
Children & youth
Diagnosis, Differential
Diagnostic tests
Emergency medical care
Europe (West)
Fever
Fever - diagnosis
Fever - drug therapy
Fever - etiology
Follow-Up Studies
Humans
Male
Meningitis
Pain
Pneumonia
Pneumonia, Pneumococcal - complications
Pneumonia, Pneumococcal - diagnosis
Pneumonia, Pneumococcal - drug therapy
Proteins
Radiography, Thoracic
Streptococcus infections
Streptococcus pneumoniae - isolation & purification
Unusual Presentation of More Common Disease/Injury
White
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Summary:We describe the case of a 10-year-old boy who presented with high fever, vomiting and diarrhoea. There were no respiratory symptoms and auscultation and percussion of the lungs were normal. The combination of the clinical picture with a high C reactive protein value prompted us to perform a diagnostic work-up. A chest radiograph showed abscess formation in a lobar pneumonia in the right upper lobe and intravenous antibiotic therapy was started. The patient recovered and treatment was continued with oral antibiotics. Radiologically confirmed pneumonia in a febrile patient without respiratory symptoms is described as occult pneumonia. An increased number of leucocytes and/or an increased C reactive protein value can predict occult pneumonia in febrile children. This case highlights the diagnostic challenge of pneumonia in febrile children without respiratory symptoms and reminds clinicians to consider occult pneumonia in the differential diagnosis of fever without source.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr.01.2012.5521