Case 4: Stridor in a 4-year-old Girl

Presentation

A 5-year-old girl presents to our outpatient department with a history of persistent cough, difficulty breathing, and low-grade fever off and on for the past 6 months. Her cough is nonproductive, mostly nocturnal, and exacerbated by exercise. Her respiratory distress settles at rest. Currently, she is not taking any medications. Her parent reports a body temperature as high as 100.0°F (37.8°C). There is no history of chest pain, weight loss, vomiting, persistent diarrhea, past allergies/asthma/wheezing, or contact with anyone having tuberculosis. She has received multiple courses of antibiotics and cough syrups on different occasions without any relief of symptoms. The girl was born vaginally at term after an uneventful pregnancy. She was immunized according to the Expanded Program on Immunization schedule of the World Health Organization.

On examination she does not have any dysmorphic features, is active and alert, and has no respiratory distress. Her respiratory rate is 25 breaths/min, heart rate is 88 beats/min, blood pressure is 95/60 mm Hg, temperature is 98.6°F (37.0°C), and oxygen saturation on a pulse oximeter is 94% on room air. Her weight, height, and BMI are at the 50th percentile for age and sex. An inspiratory stridor is audible on close attention. There is no clubbing, cyanosis, or use of accessory muscles of respiration. The chest movement is symmetrical, air entry is equal bilaterally, and there …