A case study of a child with Down syndrome: a dilemma for the accompanying pulmonary impairment

Abstract

This is a 12-year-old boy with proven trisomy 21 (Down syndrome). During the last calendar year, a series of severe inflammatory manifestations of the lower respiratory tract began. Before the fi rst hospitalization, he was in a serious general condition, with a pronounced biological syndrome of inflammation (CRP – 197 mg/L), but without leukocytosis. Oxygen saturation was 60%. The performed chest radiograph showed left-sided lung destruction and a multifocal inflammatory-infiltrative process in the right lung. In the following months, an active exacerbation of the manifestations of respiratory failure and radiographic progression of pulmonary changes followed. A new chest CT scan was performed – with data on consolidation of the parenchyma in both lobes of the left lung to the extent of atelectasis. In the right lung – middle and lower lobes, extensive ground glass areas, emphysema in the right apical and dislocation of the mediastinum. The subsequent chest X-ray showed no changes compared to the previous one, except for marking the interlobe on the right. After consultation with a thoracic surgeon, a left-sided pulmonectomy was proposed. In the mycograms performed at the same time, a result was obtained proving the presence of Paecilomyces spp. Due to the negative result for Aspergillus, the treatment started with Voriconazole was changed to Itraconazole according to the obtained result. At present, the patient is at the end of the first month of his treatment cycle with itraconazole, and a new imaging study is to be conducted to assess the effect of the treatment.