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Unusual cause of dyspnoea


A 4-year-old boy was admitted to our department with fever, cough and dyspnoea, unresponsive to salbutamol and antibiotic therapy. He had previously contracted bronchiolitis at 20 days of life, followed by intermittent episodes of wheeze that never required hospitalisation and responded to short inhaled corticosteroid cycles. He had an atopic family history. On examination, he had dyspnoea, persistent cough with bronchospasm but normal oxygen saturations. Bloods showed elevated eosinophils (2004 µL), a slightly elevated C-reactive protein (1.5 mg/dL) and total IgE (326 kU/L), and specific IgE was raised for various inhalant allergens (box). A chest X-ray was performed (figure 1).


Positive inhalant allergens

  • Anthoxanthum odoratum

  • Cynodon dactylon

  • Dactylis glomerata

  • Dermatophagoides farinae

  • Dermatophagoides pteronissimus

  • Holcus lanatus

  • Poa pratensis

  • Phleum pratense

Figure 1

Chest X-ray of the patient.

Questions 1. What does the chest X-ray in figure 1 show?

  1. interstitial pneumonia

  2. pneumothorax

  3. lung atelectasis with mild mediastinal shift

  4. diffuse air trapping

  5. enlargement of right hilar lymph nodes


2. Given the clinical picture and the chest X-ray, what would your differential diagnosis include from the following?

  1. plastic bronchitis (PB)

  2. mycoplasma infection

  3. tuberculosis

  4. foreign body aspiration

  5. lung perforation

3. Are any of these conditions not associated with a specific type of cast/PB?

  1. Fontan procedure

  2. haemophilia

  3. lymphatic abnormalities

  4. asthma and other allergic disorders

  5. sickle cell disease.

  • paediatrics
  • plastic bronchitis
  • bronchial cast
  • asthma
  • respiratory medicine

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