Occult pneumonia in a child

• 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
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr.01.2012.5521

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.