Persistent Pneumonia in an Infant

Abstract

A 4-month-old boy with past medical history of eczema presented with fever and cough; a chest radiograph showed lung consolidation, and he was initially treated with amoxicillin for presumed community-acquired pneumonia. After several days, his fever persisted. He was also profoundly anemic. Antibiotic coverage was broadened because of the concern for resistant organisms; he began to improve and was discharged from the hospital. However, at 5 months of age, his fever returned, and he continued to demonstrate lung consolidation on chest radiograph. Additionally, he had lost weight and continued to be anemic. Splenic cysts were noted on abdominal ultrasound. He was diagnosed with an unusual etiology for his pneumonia and improved with the appropriate therapy. An underlying immunodeficiency was suspected, but initial testing was nondiagnostic. At 12 months of age, he presented with another infection, and the final diagnosis was made.

FIGURE 1

The patient’s chest radiograph from his first admission demonstrated a consolidation in the lateral right middle lobe. The heart border is spared as the medial aspect of the right middle lobe is uninvolved.

FIGURE 2

Chest radiograph revealed a large consolidation in the lateral right middle lobe and smaller areas of consolidation in the bilateral lower lobes.

FIGURE 3

The patient’s growth chart at the time of his second admission demonstrated a 1-kg weight loss over a 1-month period (larger arrow). The patient’s growth chart after his treatment for PJP demonstrated healthy weight gain, and he began following the 50th percentile (smaller arrow).