In this article, Dr Anuj Rastogi presents a case of unresolved cough in a 6-year-old child with a history of mild respiratory distress and tachypnea. He also advises on how to proceed if the patient does not respond significantly to the initial treatment. 

The case

I was confronted with a 6-year-old who was already undergoing inhalation therapy and had mild respiratory distress, tachypnea, and an oxygen saturation of 84% at room air. Since receiving treatment three months ago, the child had also lost weight. As a result, I immediately realised that this is not asthma because there were no limitations in the expiratory flow. I advised getting an HRCT scan, which showed that the lung field looked like ground glass. Her elder sister had the same presentation. 

Diagnosis

I started administering methylprednisolone to the younger child after admission. After doing her BAL (Bronchoalveolar lavage), it was determined that Staph was heavily proliferating. Since Aureus and her bio fire both tested positive for the same thing, we started with anti-Staph medications for 1.5 months.

However, there was no significant improvement. The need for oxygen only slightly decreased. Therefore, a lung biopsy was conducted, which detected hypersensitivity pneumonitis. A hypersensitivity panel in this case revealed mucor-rhizopus. As a result, hypersensitivity pneumonitis was identified in both cases.