Báo cáo y học: A rare cause of specific cough in a child: the importance of following-up children with chronic cough

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: A rare cause of specific cough in a child: the importance of following-up children with chronic cough...
Nội dung trích xuất từ tài liệu:
Báo cáo y học: "A rare cause of specific cough in a child: the importance of following-up children with chronic cough"Cough BioMed Central Open AccessCase reportA rare cause of specific cough in a child: the importance offollowing-up children with chronic coughRichard Lloyd Barr1, David John McCrystal2, Christopher Francis Perry3 andAnne B Chang*4Address: 1Senior Resident, Royal Childrens Hospital, Herston Rd, Brisbane, Qld 4029, Australia, 2ENT Registrar, Royal Childrens Hospital,Herston Rd, Brisbane, Qld 4029, Australia, 3Consultant in ENT Surgery, Royal Childrens Hospital, Brisbane; Herston Rd, Brisbane, Qld 4029,Australia and 4Consultant Respiratory Physician, Dept of Respiratory Medicine, Royal Childrens Hospital, Brisbane; Herston Rd, Brisbane, Qld4029, Australia; and A/Professor of Paediatrics, University of Queensland, Herston Rd, Brisbane, AustraliaEmail: Richard Lloyd Barr - Richard_Barr@health.qld.gov.au; David John McCrystal - David_McCrystal@health.qld.gov.au;Christopher Francis Perry - cpmedical@hotkey.net.au; Anne B Chang* - annechang@ausdoctors.net* Corresponding authorPublished: 21 September 2005 Received: 13 July 2005 Accepted: 21 September 2005Cough 2005, 1:8 doi:10.1186/1745-9974-1-8This article is available from: http://www.coughjournal.com/content/1/1/8© 2005 Barr et al; licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract For many years, the term specific cough has been used as a clinical cough descriptor in children to signify the likelihood of an underlying disease causing the cough. In this case study, we describe a child with specific cough caused by a rare carcinoma, a mucoepidermoid carcinoma of the bronchus. The cough only totally resolved after the primary cause was successfully treated. This report highlights the importance of following up children with cough, especially those with specific cough. x-ray (CXR) showed right upper lobe (RUL) collapse,Clinical RecordAn 8-year-old girl from a remote Aboriginal community tram-tracks signs and increased peribronchial and intersti-approximately 2500 km from Brisbane was transferred to tial markings of the right lower lobe. These CXR changesour hospital for management of a bronchial lesion. She were documented at least 4-months ago (figures 1 and 2).had received 7-days of intravenous amoxicillin prior to Chest high resolution computerised tomography (CT)transfer. She had a 4-year history of daily wet and some- scan revealed RUL collapse and severe cystic bronchiecta-times productive cough, which was worse on exertion. sis and cylindrical bronchiectasis of the right middle andThere was no history of exertional dyspnoea, haemoptysis lower lobes (figures 3 and 4). Sputum cultures grewor weight loss. She also had a history of recurrent admis- Moraxella catarrhalis, and the microscopy was negative forsions for pneumonia at the local hospital (3 in the past 6 acid-fast bacilli. Mantoux tests (M. tuberculum, M. Avium)months). In the childs community, two adults were were negative, sweat test and immunological workup wererecently diagnosed with active pulmonary tuberculosis. normal. Flexible bronchoscopy revealed a large lesion at the carina (Figure 5). Rigid bronchoscopy was then imme-On arrival, the child was thin (weight 5th percentile, diately performed during which the lesion was only par-height 25th), appeared well and had a wet cough, reduced tially removed piecemeal because of the presumedair entry over the right side and inspiratory crepitations. diagnosis of tuberculosis and length of time required toSpirometry values were invalid as she could not ade- remove the bulk of the lesion (2-hours). Given the signif-quately perform maximum expiratory manoeuvres. Chest icant tuberculosis contact, anti-tuberculous medications Page 1 of 5 (page number not for citation purposes)Cough 2005, 1:8 http://www.coughjournal.com/content/1/1/8 Figure child from referral hospital 4 months ago increased CXR of 2 changes from CXR taken showing minimalFigure 1Chest x-ray of the child 4 months before referral CXR of child f ...