Acute scoliosis as an unusual presentation of pneumonia: A case report. Issue 24 (June 2018)

• Record Type: Journal Article
• Authors: Atwal, Rajan; Stewart, Charles
• Other Names: NA. section editor.
• Is Part Of: Medicine. Volume 97:Issue 24(2018)
• Publication Date: 2018-06
• Subjects: paediatrics -- pneumonia -- scoliosis; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000010580
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract : Abstract: We describe the unique case of a child with pneumonia presenting with acute scoliosis and abdominal pain, without any typical features of the disease. A 10-year-old girl presented to the emergency department on 3 consecutive days with right-sided abdominal pain. There were no associated features, in particular, no fevers or respiratory symptoms. On the first 2 presentations, observation, examination, and blood test findings were unremarkable. Chest x-ray and abdominal ultrasound were also normal. On the third presentation a marked scoliosis was noted and abdominal examination revealed right-sided tenderness with rebound. The patient was admitted and a computed tomographic scan of the abdomen arranged. Unexpectedly, this revealed a right lower lobe pneumonia and associated pleural effusion. Despite treatment, the parapneumonic effusion enlarged rapidly and she developed respiratory distress, necessitating transfer to a tertiary centre. The diagnosis of pneumonia can be challenging because of a lack of respiratory signs, the masking of systemic features by antipyretic effects of first-line analgesics, and a high rate of false-negative chest radiographs. The development of acute scoliosis should lead the clinician to strongly consider pneumonia in such circumstances.