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Case 2: Acute Respiratory Distress and Facial Petechiae in a 4-month-old Boy

Alpa Patel Shah and Mary Lu Angelilli
Pediatrics in Review September 2016, 37 (9) 394-396; DOI: https://doi.org/10.1542/pir.2016-0011
Alpa Patel Shah
*Children’s Hospital of Michigan, Detroit, MI.
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Mary Lu Angelilli
*Children’s Hospital of Michigan, Detroit, MI.
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  1. Alpa Patel Shah, DO*
  2. Mary Lu Angelilli, MD*
  1. *Children’s Hospital of Michigan, Detroit, MI.
  • AUTHOR DISCLOSURE

    Drs Shah and Angelilli have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A 4-month-old twin infant boy presents to the emergency department (ED) with a 10-hour history of increased work of breathing, poor feeding, and decreased activity. Prior to arrival, the patient’s mother administered 2 albuterol treatments via nebulizer, which helped transiently. Then she took the child to his pediatrician’s office, where he was given an additional albuterol treatment and subsequently referred to the ED for persistent respiratory distress. The infant has had 2 hospital admissions for bronchiolitis. His parents deny any history of fever, cough, wheezing, runny nose, or vomiting. His twin brother remains asymptomatic.

In the ED, the child is alert but tachypneic, with intercostal and subcostal retractions and nasal flaring. His initial vital signs include a temperature of 37.8°C (100°F), heart rate of 174 beats per minute, respiratory rate of 34 breaths per minute, blood pressure of 111/53 mm Hg, and pulse oximetry of 80% in room air. He weighs 4.8 kg (less than the third percentile). Findings on physical examination include a reddish discoloration on both sides of the neck and petechiae on the right cheek. A subconjunctival hemorrhage is also noted in the right eye. His lungs are clear to auscultation bilaterally, without wheezing, stridor, rales, or crackles, despite persistent and …

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Pediatrics in Review: 37 (9)
Pediatrics in Review
Vol. 37, Issue 9
1 Sep 2016
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Case 2: Acute Respiratory Distress and Facial Petechiae in a 4-month-old Boy
Alpa Patel Shah, Mary Lu Angelilli
Pediatrics in Review Sep 2016, 37 (9) 394-396; DOI: 10.1542/pir.2016-0011

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Case 2: Acute Respiratory Distress and Facial Petechiae in a 4-month-old Boy
Alpa Patel Shah, Mary Lu Angelilli
Pediatrics in Review Sep 2016, 37 (9) 394-396; DOI: 10.1542/pir.2016-0011
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More in this TOC Section

  • Sudden Unilateral Vision Loss in a Teenage Girl
  • A Teenage Boy with Right Forehead Swelling Following Trauma to the Head
  • Tachypnea and Epistaxis in a Full-term Infant
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