Recurrent Pneumonia in a 15-year-old Girl

摘要

A previously healthy 15-year-old girl presents with a history of back pain, chills, and shortness of breath of 1 day's duration. On examination she is afebrile and well appearing despite mild tachypnea (respiratory rate of 24 breaths/min). Oxyhemo-globin saturation is normal (95%-100%) on room air. On auscultation she has absent sounds in the left lower lung (LLL) fields but normal breath sounds on the right. Initial laboratory tests show a white blood cell count of 13,050/μL (13.05 x 10~9/L), a hemoglobin level of 14.1 g/dL (141 g/L), a hematocrit value of 40.5%, and a platelet count of 226 x 10~3/μL (226 x 10~9/L). A basic metabolic panel is normal, and lactate dehydrogenase and uric acid levels are within their respective reference ranges. The C-reactive protein level is elevated at 8.56 mg/L (81.53 nmol/L). A chest radiograph (CXR) reveals a large area of consolidative opacity in the left hemithorax (compatible with pneumonia and/or atelectasis) and probable pleural effusion (Fig 1).