Persistent paralysis after vecuronium administration.
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Biomedical subjects
Publications and source records attributed to E E Conway.
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This case illustrates an unusual cause of respiratory distress in the pediatric population. A high degree of suspicion is necessary to make the diagnosis of plastic bronchitis. Wheezing and cough will lead to the diagnosis of reactive airway disease and/or foreign body aspiration. Chest radiographs may yield additional information, but the diagnosis is made by bronchoscopy and removal of the casts. Any child with severe respiratory distress refractory to aggressive conventional medical therapy and with a history or radiograph suggestive of plastic bronchitis should be considered a candidate for bronchoscopy. As clinicians, we must always remember the dictum, "All that wheezes is not asthma."
A previously healthy 12-year-old girl presented with fever and mental status changes without focal neurologic deficit. A CBC and computed tomography scan revealed thrombocytopenia and an intracranial bleed. Further laboratory studies were consistent with systemic lupus erythematosus. This case emphasizes the need to maintain a high index of suspicion for atypical presentations of an uncommon childhood illness.
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