3 year Old Boy With A Cough

A mother brings her 3 year old boy to the pediatrician because he has had a barking cough for 2 days. She says that he goes to day care 5 days a week and that some of the other children there are suffering from similar symptoms. Mother tells that the child has no trouble breathing but his cough is loud, he has a runny nose and temperatures up to 101 F during the past 2 days. His voice is a little horse and his mother says that he has had colds in the past but none were associated with this type of cough.
Examination shows:

• Red nose with sniffing often.
• Minimal pharyngeal erythema.
• No pharyngeal exudates.
• Mild cervical lympadenopathy.
• Mild coarse breath sounds on auscultation of the lungs but no wheezing. 

Vitals: 

Temperature: 100 F

Heart rate : 100 bmp

BP : 95/45 mm Hg

Respiratory rate: 20 breaths/min

X ray of the chest is shown blow:

and the X- ray of the neck

 What is the Differential Diagnosis?

• Bacterial pharyngitis.
• Tonsillitis.
• Croup.
• Epiglottitis.
• Bronchiolitis.
• Aspirated foreign body.

The lab work in this patient was negative for rapid streptococcal antigen test and a negative throat swab culture. Chest x ray shows features suggestive of croup.

Final Diagnosis : Croup

Case Discussion:

CROUP

Croup is a condition that is cause by acute inflammation of the larynx due to parainfluenza virus type 1 ( most common) or parainfluenza virus type 2 or 3, respiratory syncytial virus, influenza virus, or adenovirus.

Age: It is most commoly seen in children 3 months to 5 years of age. 

Clinical features:

• Barking cough.
• Nasal congestion.
• Dyspnea
• Fever
• Mild pharyngeal erythema
• Sometimes respiratory distress in severe cases.

X Ray findings: X - Ray of the neck may show a steeple sign  (i.e subglottic narrowing of the airway) but it is not always needed for a diagnosis.

Treatment:

1. Supportive care with hydration, analgesics, rest and humidified air. 

2. Inhaled corticosteroids or epinephrine may be indicated for severe cases.

3. Patients typically can be treated as out patients and the condition is expected to self resolve. 

4. If there is respiratory distress the child may be admitted for observation.