What's Your Diagnosis? Pediatric Sickle Cell Disease

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got the previous case on Emergency Department Management of Acute Scrotal Pain in Pediatric Patients right.

Case Presentation: Emergency Department Management of Acute Pediatric Sickle Cell Disease Complications

A 15-year-old boy with sickle cell disease presents with cough, congestion, and fever…

The boy’s symptoms have progressed over 2 days, with a temperature of 38.9°C starting 1 hour ago.
The boy’s vital signs are: heart rate, 120 beats/min; respiratory rate, 29 breaths/min; and oxygen saturation, 88% on room air. Auscultation reveals decreased breath sounds in the right lower lobe. Chest x-ray shows a right lower lobe infiltrate. You place the boy on nasal cannula for oxygen support.
What is the differential diagnosis? How should you manage this patient?

Case Conclusion!

You diagnosed the boy with ACS based on the hypoxia, fever, and infiltrate on chest x-ray. You initiated treatment with appropriate broad-spectrum IV antibiotics to avoid worsening of his condition. Respiratory supportive care was indicated to improve hypoxia that might otherwise worsen his status and outcome. The patient required a blood transfusion due to the degree of hypoxia from the pulmonary infection. The patient was admitted to the pediatric hematology/oncology service for further management.