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June 1989

Radiological Cases of the Month

Author Affiliations

Contributed from the Departments of Pediatric Pulmonology (Drs Bokulic and Beckerman) and Pediatric Radiology (Dr Mulvihill), Tulane University School of Medicine, New Orleans, La.

Am J Dis Child. 1989;143(6):747-748. doi:10.1001/archpedi.1989.02150180129035

A 22-year-old man with cystic fibrosis (CF) developed tachypnea, fever (temperature, 38.4°C), increased cough, and dyspnea. He also complained of a sore throat, generalized myalgias and arthralgias, diaphoresis, and chills. He was treated with nebulized tobramycin sulfate and oral ciprofloxacin hydrochloride. Bilateral wrist swelling and aching had begun 3 weeks prior to his respiratory symptoms. Because his pulmonary symptoms did not improve with outpatient therapy, the patient was admitted to the hospital.

His vital signs on admission were a temperature of 36.8°C, a heart rate of 148 beats per minute, a respiratory rate of 28/min, and a blood pressure of 131/61 mm Hg. The physical examination revealed a barrel chest, diffuse crackles on auscultation, and severe clubbing of the digits. There was bilateral nontender swelling and deformity of the wrist (Fig 1).

The laboratory results showed a white blood cell count of 10.7 × 109/L with 0.59 segmented

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