A 7-YEAR-OLD girl was admitted to the hospital for a second time because of 2 days of cough, difficulty breathing, fever, anorexia, and fatigue. She had a 1-year history of weight loss and occasional choking on food. She denied nausea, vomiting, and hemoptysis. There were no known ill contacts. Six weeks earlier, she had been hospitalized for presumed aspiration pneumonia. Chest radiography (Figure 1), computed tomographic scanning, and magnetic resonance imaging were performed. Initial laboratory tests revealed a leukocyte count of 6.4×109/L with a normal differential; hemoglobin level, 9.4 g/L; hematocrit level, 0.29; mean corpuscular volume, 63.5 fL; and platelet count, 498×109/L. The patient had no response to intradermal tuberculin, coccidioidin, and Candida tests. Testing for mycoplasma IgM antibody yielded positive results. Tests for IgG and IgM antibodies for coccidioidomycosis and for human immunodeficiency virus were negative. Nasopharyngeal culture was positive for parainfluenza type III virus.
Gannett MB, Rhee KH, Barton LL. Radiological Case of the Month. Arch Pediatr Adolesc Med. 1995;149(11):1265-1266. doi:10.1001/archpedi.1995.02170240083013