Cautionary Tales of Tachypneic Infants in the Bronchiolitis Season

Published Date: 15th August 2018

Publication Authors: Chilukuri L

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Abstract

Although the diagnosis of bronchiolitis is usually straightforward, cardiac, metabolic, musculoskeletal and hematological conditions may present in a similar way and therefore, should not be overlooked.

Methods

We describe four cases presenting with increased work of breathing that were treated initially as bronchiolitis. However, the progressive clinical course of these cases and further investigations revealed an alternative diagnosis. 

Results

The first case was a 36-week baby boy who presented with symptoms of bronchiolitis and was treated accordingly. A slow response to treatment and a subsequent CT scan revealed the diagnosis of congenital lobar emphysema, which needed resection. Another 7-month old child with similar clinical presentation, was found to have a white cell count of 1032 x 109/l, Hemoglobin 34g/l; platelets of 30 x 109/l. The blood film confirmed the diagnosis of Acute Lymphocytic Leukemia. A third case of a 9-week baby girl showed persistent tachypnea and intermittent grunting out of proportion to her chest signs. Her blood gas revealed metabolic acidosis, urine was persistently alkaline and renal ultrasound showed nephrocalcinosis leading to the diagnosis of distal renal tubular acidosis. Finally, we had 4-week old boy presenting with symptoms suggestive of bronchiolitis, that was subsequently confirmed to be pulmonary vein stenosis. 

Conclusion

This case series demonstrated that rare respiratory and non-respiratory conditions can mimic the presentation of common conditions such as bronchiolitis. This highlights the importance of a detailed history and examination in infants presenting with increased work of breathing. When atypical findings are present or there is a delay in response to standard treatment, seeking senior or specialist review and thinking out of the box, is vital.

 

Chilukuri, L; Aziz, A; Maddipati, T. (2018). Cautionary Tales of Tachypneic Infants in the Bronchiolitis Season. Pediatric Pulmonology. 53 (S1), S167

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