Persistent Pneumonia in an Infant

Area of Science:

• Pediatric Pulmonology
• Infectious Diseases
• Immunology

Background:

• A subacute febrile illness with multifocal cavitary lung consolidations presented in an 8-month-old boy.
• The patient's condition deteriorated despite broad-spectrum antibiotic therapy, progressing to respiratory distress, hepatosplenomegaly, bicytopenia, and hepatic dysfunction.

Purpose of the Study:

• To investigate the underlying cause of persistent pneumonia and severe systemic illness in an infant.
• To identify causative pathogens and associated underlying immunodeficiency.

Main Methods:

• Diagnostic workup included Dihydrorhodamine assay and genetic analysis for immunodeficiency.
• Postmortem investigations involved blood cultures, autopsy with histopathological examination, and conventional PCR targeting 16S ribosomal DNA.

Main Results:

• The patient was diagnosed with chronic granulomatous disease (CGD).
• Postmortem blood cultures identified Burkholderia cenocepacia.
• Autopsy revealed necrotizing granulomatous inflammation with extensive necrosis and abscesses in the lungs.
• Conventional PCR identified Nocardia pseudobrasiliensis in lung tissue.

Conclusions:

• This case underscores the importance of invasive investigations for identifying causative organisms in severe, refractory pediatric pneumonia.
• Early diagnosis of underlying conditions like CGD is crucial for appropriate antimicrobial selection and management.
• The identification of multiple pathogens (B. cenocepacia and N. pseudobrasiliensis) in a CGD patient highlights the complexity of infections in immunocompromised individuals.