title: Interstitial lung disease and profound hypoxaemia in a severely-malnourished child with very severe pneumonia and potential lymph-node tuberculosis: an uncommon but serious co-morbidity.
abstract: A nine-month old boy was initially admitted at the Acute Respiratory Infection Unit of Dhaka Hospital of icddr,b and soon after transferred to the Intensive Care Unit of the same hospital. The boy had problems of very severe pneumonia (confirmed by radiology), severe hypoxaemia, severe malnutrition, and Down's syndrome. The patient was treated according to the hospital protocol for the management of pneumonia and malnutrition. During the hospital stay, hypoxaemia was persistent with very little improvement of pneumonia; a number of differentials, such as pneumocystis jirovecii pneumonia, lymph-node tuberculosis, were added to the problems. Subsequently, the patient's hypoxaemia improved with the empirical use of antitubercular drugs. However, the patient again developed persistent hypoxaemia and, after unsuccessful treatment for a hospital-acquired pneumonia, the problems further expanded to include interstitial lung disease (ILD). This was confirmed by high-resolution computed tomography, and the patient was treated with prednisolone for 6 months, along with antitubercular drugs. He fully recovered from ILD, hypoxaemia, and pneumonia both clinically and radiologically. Therefore, severely-malnourished children having wet cough and pneumonia with persistent hypoxaemia should be assessed for the possible existence of interstitial lung disease. This may help provide a prompt and appropriate management to reduce morbidity and deaths in such patients.
authors.affiliation: ICU Dhaka Hospital, icddr,b, GPO Box 128, Dhaka 1000, Bangladesh. chisti@icddrb.org
authors.forename: Mohammod J
authors.initials: MJ
authors.lastname: Chisti
authors.forename: Irin
authors.initials: I
authors.lastname: Parvin
authors.forename: Hasan
authors.initials: H
authors.lastname: Ashraf
authors.forename: Haimanti
authors.initials: H
authors.lastname: Saha
authors.forename: Fariha B
authors.initials: FB
authors.lastname: Matin
authors.forename: Mark A C
authors.initials: MA
authors.lastname: Pietroni
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D001459:Bangladesh; D015897:Comorbidity; D003428:Cross Infection / Q000150:complications; D003937:Diagnosis, Differential; D004314:Down Syndrome / Q000150:complications; D006801:Humans; D000860:Hypoxia / Q000150:complications* / Q000188:drug therapy; D007223:Infant; D017563:Lung Diseases, Interstitial / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D008297:Male; D044342:Malnutrition / Q000150:complications*; D045363:Pneumocystis carinii; D011014:Pneumonia / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D011239:Prednisolone / Q000627:therapeutic use; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014388:Tuberculosis, Lymph Node / Q000150:complications* / Q000188:drug therapy
chemical_list: D000893:Anti-Inflammatory Agents; D000995:Antitubercular Agents; D011239:Prednisolone