Staphylococcal tracheitis, pneumonia, and adult respiratory distress syndrome

A child initially seen in the emergency department with respiratory distress was diagnosed with viral laryngotracheitis and discharged home on oral steroids. She returned the following day without abatement of her symptoms and was admitted with upper airway obstruction and pneumonia. Bacterial tracheitis was diagnosed when the tracheal aspirate grew a pure culture of Staphylococcus aureus. Hemodynamic instability and severe parenchymal lung disease ensued from septic shock and adult respiratory distress syndrome requiring inotropic support and assisted ventilation. Oscillatory ventilation was instituted when the patient failed conventional ventilation.