Table 1 Investigations

Case 1

Case 2

Haematology

 Leucocyte peak (×109/L)

18.3

19.0

 Neutrophil peak (×109/L)

15.2

13.7

 Lymphocyte peak (×109/L)

3.5

2.3

 Eosinophil peak (×109/L)

0.9

2.5

 Platelets

Normal

Normal

 Haemoglobin nadir (g/L)

79

74

 ESR (mm/hour)

104

44

Biochemistry

 Creatinine peak (umol/L)

Normal

153

 CRP peak (mg/l)

321

280

 ALT (IU/L)

122

Normal

Microbiology

Nasal swab: Moraxella catarrhalis

Ear swab: Pseudomonas aeruginosa

Sputum negative for acid-fast bacilli, PCR negative

ASOT 1600 IU/ml

No growth on blood or urine culture

Negative viral throat swab and MCS throat swab

No positive microbiology including Monospot,

Mantoux and TSpot

Urine dipstick

On day of admission:

1+pro, 4+Hb, 2+leu, 2+ket

One week into admission:

3+pro, 4+Hb, 2+leu, 2+ket

Three days prior to admission:

2+Hb, otherwise normal

Radiology

Echocardiogram: normal

CXR at admission: normal

CXR after 1 week: see figure 1

CT head: pansinusitis

Abdominal USS: mild hepatomegaly, diffusely echogenic kidneys

Echocardiogram: normal

CT chest at local hospital: see figure 2

CXR on admission to PICU: bilateral consolidation with rounded lucency in right lower zone suggestive of cavity formation

  • ALT, alanine aminotransferase; ASOT, anti-streptolysin O titre; CRP, C-reactive protein; CT, computed tomography; CXR, chest X-ray; ESR, erythrocyte sedimentation rate; Hb, haemoglobin; leu, leucocytes; ket, ketones; MCS, microscopy, culture, and sensitivity; PICU, paediatric intensive care unit; pro, protein; TSpot, measures T lymphocytes primed to Mycobacterium tuberculosis antigens; USS, ultrasound scan.