Unconventional Manifestations of Pediatric Pneumonia: Clinical Insights into an Atypical Case

Introduction Atypical community-acquired pneumonia is a common yet potentially fatal infection in children, particularly when classical clinical signs and symptoms are absent. Case Report A 7-year-old Hispanic male with a history of developmental delay, umbilical hernia, and ADHD presented to the pediatrician’s office with a chief complaint of intermittent fevers and cough over the past 6 days. His caregivers noted that the fever recurred every other day, with temperatures ranging from 100-102°F, and reported the onset of hives and swelling in the hands and feet on the 5th day. The patient had a negative screening for a rapid COVID, streptococcal, and influenza A/B test. He was sent to the hospital for a chest x-ray which revealed right upper lobe pneumonia. The patient received Azithromycin 200mg/5mL oral liquid 6.3mL on day 1 and 3.1mL for days 2-5 and Amoxicillin 400mg/5mL at 7mL q12h for 10 days, and loratadine 5mg/mL at 5 mg oral daily for 14 days. Conclusion One in five cases of pneumonia are atypical in the pediatric population with chances as high as 56% presenting asymptomatically which can make it challenging to diagnose. ¹ Classic presentation of atypical pneumonia present as the following: cough, fever, muscle ache. In this patient he presents with ambiguous symptoms. Patient followed-up two weeks later and reported abscess drainage on his head and he developed reactive adenitis. Outside of developing reactive adenitis due to an unrelated cause he recovered completely from the pneumonia. 10/25/24 - he developed reactive adenitis with 2 nodules noted on the superior region of head that was draining. He received clindamycin 75mg/5mL, 5ml TID for 10 days.