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PRESENTING FELLOW

Dr. Anne O'Donnell
Respiratory Fellow, Alberta Children's Hospital
Calgary, Alberta, Canada

THE CASE

a twelve year old boy presented to a regional hospital with acute pneumonia and a twelve month history of progressive dyspnea.

HISTORY

Initial Presentation
A 12 year old boy presented to a regional hospital with a 3 week history of productive cough and night sweats. On examination he was hypoxic with crackles in both bases. A chest radiograph showed bibasalar increased markings. A diagnosis of acute bacterial pneumonia was appropriately made and he was treated with intravenous Cefuroxime as well as oxygen via nasal prongs with no improvement after 3 days.

Further history revealed 12 months of progressive dyspnea, initially with exercise and recently with climbing stairs. He had no history of wheeze or cough. He had not traveled outside Canada and was a non smoker.

Past medical history
He was born at term with no complications. He was not taking any regular medications apart from Chinese herbs. He had not had any surgery. He had not been immunized. There was a family history of Von Willebrands disease but no other medical conditions.

His medical history was essentially unremarkable, with no previous hospital admissions. He had been seen in the emergency department twice, once with abdominal pain and once with acute dyspnea. No diagnosis was reached at either visit and symptoms settled with minimal treatment.

Further questioning revealed a 2 month history of occasional cramping abdominal pain in the upper abdomen, on average 3 times a day, usually after meals and particularly those containing wheat. He described some constipation, but there was no diarrhea, no vomiting and no blood loss. There had been no contact with other people with illness. Over the past 3 months he had lost approximately 10 lb in weight.

WHAT DIAGNOSES ARE YOU CONSIDERING?


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