A 12-month-old boy presented with difficulty of breathing, cough, frequent interruptions of breastfeeding, and high-grade fever of 3 days to the paediatric department. He was born at 42 weeks of gestational age (birth weight: 3300 grams) after an uneventful pregnancy. He is an only child to nonconsanguineous parents. His past history was notable for being treated three times (out-patient and in-patient) for pneumonia since 2 months of age. He had multiple episodes of acute diarrhoea.
Examination
On physical examination, he was acutely sick-looking with marked respiratory distress. His temperature was 38.7°C, respiratory rate 72 per minute, pulse rate 145 per minute, and his saturation of oxygen at room air measured 77%. He was underweight (5 kg) and stunted (59 cm) with an age-appropriate head circumference (47 cm). He had pink conjunctivae with nonicteric sclerae. He had flaring of ala nasi, intercostal and subcostal retractions, bilateral bronchial breath sounds, and fine crepitations in the right lung field. There were normal heart sounds with no murmur or gallop. He had no organomegaly or signs of fluid collection on abdominal examination. There were no active lesions or oedema. No skeletal deformity or focal neurologic deficit was noted.
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