Pneumonia With Chest Wall Invasion in a School-Aged Child.

Abstract

CASE REPORT The patient is an 11-year-old autistic boy, who presented with a right chest wall mass of unknown duration. Intermittent tactile fever and cough were noted during the 4 days prior to presentation. Retrospectively, the parents noted decreased energy and an unwillingness of the boy to wear his school backpack, associated with complaints of right chest and rib pain over the past several months. He had no weight gain or loss, and no other respiratory symptoms were noted. The boy had a history of periodontal disease, requiring general anesthesia for teeth extractions, and the placement of fillings, crowns, and a spacer 9 months prior to presentation. His immunizations were current and he was not taking any medications. He lived in the suburban Midwest with his parents, both of whom were born in China. He was born in the United States and traveled only domestically to Washington D.C. and Orlando, Florida in the past year. The boy’s parents had never been treated for active or latent tuberculosis. The boy had no other known tuberculosis exposures. There was no relevant family history, including malignancy. There were no household pets or other animal exposures. Physical examination revealed an anxious but well appearing patient. He was afebrile, hemodynamically stable, and saturating well on room air. An 8 × 10 cm firm, immobile mass was noted superior and medial to the right nipple, with overlying erythema and tenderness to touch. Breath sounds were diminished in the right middle and lower lung fields. Crowns were present over the most posterior mandibular molars bilaterally. The surrounding gingival mucosa was healthy and without evidence of inflammation. The remaining exam was unremarkable. A complete blood count was significant for a white blood cell count of 16 K/μL (reference range, 3.5–12.3 K/μL), hemoglobin 9.1 g/dL (reference range, 11.3–15.2 g/dL), and