Pneumonia

A two-year-old child presented to the emergency room (ER) with high-grade fever, poor feeding, and vomiting for 2 days. Her sleep was disturbed, and she was not active. There was no present or past history of wheezing. Her birth weight and developmental milestones were normal. She was immunized up to date as per the national immunization schedule. There was no history of environmental smoke exposure. On examination, the child was ill-appearing and lethargic. There was no cyanosis. She was febrile, with a respiratory rate of 72 breaths per minute and oxygen saturation of 92% in room air. There was increased work of breathing in the form of lower chest wall indrawing and nasal flaring. Her circulatory status was normal. She was dehydrated. Auscultation of lungs in the ER was difficult in view of her restlessness. Other systems were normal. The child was admitted with a diagnosis of severe pneumonia. As there was respiratory distress, the child was started on oxygen, and she improved well. She was given intravenous (IV) fluids and IV ceftriaxone. Chest X-ray confirmed pneumonia of the left upper lobe. The child continued to show good improvement and was discharged on day 5, and a 7-day course of antibiotic therapy was completed. Blood culture was sterile. She was totally normal on follow-up.