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A 16 month old boy was brought to Saint Elsewhere Medical Center ER because of fever, runny nose, cough, and wheezing. He had several common childhood illness in the past several months including ear infection for which he was treated with amoxicillin. His mother said that his breathing is becoming more labored and he was lethargic and not eating. His sibling, a two-month old, was hospitalized lately for bronchiolitis. He was lethargic with respiratory distress on arrival at the ER. His wheezing was on both sides of the chest and his Oxygen saturation was 82% in room air. His chest X ray showed hyperinflation. He was given two treatments of albuterol by nebulizer which did not give good relief. An intravenous fluid was given and frequent albuterol treatment. The next day is oxygenation was better and the wheezing reduced. However, he is more lethargic. His peripheral circulation has worsened and his blood gases showed that he was acidotic. A common done blood test was done which revealed the surprising diagnosis. Reference: Pediatrics In Review, February 1997, page 63 Leo Leonidas, MD, FAAP, Assistant Clinical Professor in Pediatrics, Tufts University School of Medicine, Boston; Attending Pediatrician, Eastern Maine Medical Center, Bangor, Maine.
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