Clinical History.—A 13-month-old Latin-American girl was admitted to the hospital with a history of poor appetite and loss of weight. Cough and intermittent low grade fever of 3 weeks' duration were also present. There was no history of any choking episodes.
Four months prior to admission, a cousin who had active pulmonary tuberculosis lived with the family for a short period of time. Because of the exposure the health department performed tuberculin skin tests on all members of the household. The tests were all negative except for the one on the patient. Treatment was started with isoniazid.
Physical Examination.—Examination revealed a rather pale looking girl whose weight was between the third and tenth percentile and the height at the tenth percentile. (On all previous visits to the well baby clinic her weight and height were at or above 25th percentile.) Hypertympanic note and decreased breath sounds were noticed