Pneumonia that does not go away: a review of two challenging clinical cases

Abstract

Introduction: Persistent pulmonary infiltrates in children, despite adequate antibiotic therapy, represent a diagnostic challenge and require an extended diagnostic workup. Although most often it has an infectious etiology, other causes such as congenital malformations or tumor processes should be considered.

Objective: To highlight the importance of further diagnostic workup in children with persistent infiltrative opacities on lung radiological images initially treated as pneumonia, and to emphasize the importance of timely differential diagnosis.

Case report: Two pediatric patients with persistent pulmonary infiltrates are presented.

The first case refers to a seven-year-old girl with a normal personal and family history who was hospitalized due to cough and fever with moderately elevated inflammatory parameters. Radiologically, right-sided lobar pneumonia was suspected, but despite parenteral dual antibiotic therapy, the infiltrate persisted. Further work-up (CT and MR of the chest) revealed a tumor formation, which was completely surgically removed. Pathohistological findings confirmed ganglioneuroma.

The second case presents a ten-year-old boy with a history of esophageal atresia with tracheoesophageal fistula, surgically treated in infancy. From the age of six, he was frequently treated for right-sided bronchopneumonia with incomplete radiological regression. CT of the chest revealed a congenital lung malformation, which was surgically removed and pathohistologically confirmed as cystic adenomatoid lung malformation.

Conclusion: In children with persistent pulmonary infiltrates after adequate antibiotic treatment, it is necessary to perform an extended diagnostic work-up in a timely manner. Early recognition of non-infectious causes allows for timely treatment and prevention of possible complications.