A 2½-year-old white male born at term was healthy until 3 weeks of age when his mother reported that his airway seemed congested. He had numerous episodes of pneumonia diagnosed by physical examination and requiring hospitalization at 5 weeks, 7 weeks, 9 weeks, and 4 months of age. During these episodes the patient was afebrile with peaceful tachypnea, upper airway congestion, and intercostal retractions observed. No rales, rhonchi, or wheezes were reported on auscultation of the chest.
The patient seemed to improve with antibiotic therapy but continued to have notable upper airway "wheezing" and "heavy breathing." Chest roentgenograms during these hospitalizations reportedly confirmed pneumonia and showed an enlarged thymus. Sweat test and upper gastrointestinal series results were negative.
During the second year the patient had 11 episodes of pulmonary infection treated variously with amoxicillin and theophylline. A chest roentgenogram (Fig 1) was obtained on referral to the pulmonary clinic.