A 4-year-old and 3-month-old male patient presented to the doctor's office 12 hours before an episode of cough interpreted in an emergency service as an episode of acute bronchoconstriction and prednisolone.
The child is a eutrophic, term newborn, with no personal history to highlight.
Physical examination showed regular general condition, fever 38.2oC, bilateral neck tumor, soft, painful and crepitation located in the submandibular area.
The rest of the examination was normal except for acute congestive episodes (AOM).
Respiratory examination showed mild wet cough, without dyspnea or polypnea; respiratory rate 30 per minute, without draught; good bilateral airflow; disseminated subcrepitant rales.
No snoring or wheezing was auscultated (7 h ago).
The picture is interpreted as subcutaneous emphysema secondary to access to intense cough and radiographs are requested with a note to the Emergency Department for eventual hospitalization.
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The patient was admitted to hospital and read:
CAT scan was performed.
She was hospitalized for 72 h, with no evidence of prolonged wheezing and prolonged treatment with analgesia, O2 by nasal cannula, and amoxicillin for AOM.
The patient had a good clinical evolution with decreased cervical tumor, cervical pain and fever.
The chest X-ray at discharge is normal.
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On day 5 of evolution, already in ambulatory follow-up, serology was received: IgM and IgG anti-Clamidia and IgM anti-Mycoplasma pneumoniae: negative.
Anti-Mycoplasma pneumoniae IgG was positive: 1 due to indirect immunofluorescence.
It was decided to rotate amoxicillin by clarithromycin and repeat serology at 15 days of evolution.
At 15 days of evolution the patient is asymptomatic.
Serology: IgM anti-Mycoplasma: negative and IgG anti-Mycoplasma: positive 1/64 (IFI).
IgA: 108 mg/dl, IgE: 31.1 IU/ml (vn: 60-144), IgG: 818 mg/dl (vn: 315-1236), total protein: 72 mg/dl βlevalbumin: 0.949
Albumin-globulin ratio: 1.49 (normal).
After three months of evolution, the patient remains asymptomatic and without recurrences.
