Respiratory Distress and Weight Loss in a 16-year-old Boy with a History of Pancreatitis.

Abstract

1. Alexander Bowers, DO* 2. Nicholas Friedman, DO* 3. Jason Caboot, MD* 1. *Department of Pediatrics, Madigan Army Medical Center, Tacoma, WA A 16-year-old Asian American male with a history of recurrent pancreatitis (4 episodes since 4 years of age) and sinusitis (last episode around age 6 years) presents to his primary care physician with a persistent, productive cough, fatigue, and dyspnea for 2 months after being hospitalized and treated for community-acquired and eventually atypical pneumonia with ampicillin and azithromycin 1 month previously. In addition, he endorses a 15-lb weight loss over that time. His examination is significant for increased work of breathing with nasal flaring. Rhonchi are auscultated in bilateral bases of his lungs. No significant sinus tenderness, palpable lymphadenopathy, additional heart sounds or murmurs, abdominal tenderness, or edema was appreciated. His electrolyte and liver enzyme levels are normal. His white blood cell count is 14,000/μL (14×109/L), with a normal differential cell count. Chest radiographs (Figs 1 and 2) show increased bilateral perihilar markings with a right middle lobe infiltrate and an obscured cardiac silhouette. A chest computed tomographic scan (Fig 3) is obtained and shows diffuse bronchiectasis. Pulmonology is consulted for bronchoscopy with bronchoalveolar lavage (BAL), which reveals edematous bronchial mucosa and thick, purulent secretions. Respiratory cultures from the BAL fluid grow Staphylococcus aureus and Aspergillus fumigatus. Total serum immunoglobulin …