A 7-YEAR-OLD GIRL was referred with unresolved pneumonia. The patient was a mild asthmatic requiring no regular medication. Her infrequent asthmatic episodes began at 3 months of age and responded to inhalational bronchodilators.
Her present illness started 1 month before her referral. She presented with rhinorrhea, occasional cough and wheezing, and intermittent, low-grade fever. There was no history of trauma or aspiration. A chest roentgenogram was interpreted as demonstrating pneumonia at the right lung base, and she was treated with oral antibiotics. Her clinical status improved; however, because of increasing right lung opacification on a chest roentgenogram following 10 days of therapy, she was admitted for therapy with intravenous antibiotics and nebulized bronchodilators. She was transferred after 1 week because no roentgenographic improvement was observed.
Physical examination demonstrated a cooperative, afebrile child in no respiratory distress. Respirations were 20/min, and heart rate was regular at 90 beats per minute.