Abstract Introduction The differential diagnosis for solitary lung nodules in pediatrics is broad and includes granulomatous infections, inflammatory and autoimmune diseases, congenital malformations, and rarely neoplasms. We present a case of a 15-year-old boy with history of travel and farm animal exposure in Ohio. Case Presentation A 15-year-old male was hospitalized with a ten-day history of sore throat, fatigue, and headache that had worsened over the preceding three days, followed by the onset of fever and chest pain. The family reported notable weight loss over several months and recent travel to Ohio, where he had prolonged exposure to farm animals and swam in ponds, after which he developed a transient skin rash. On examination, his oxygen saturation was 98% and lungs were clear to auscultation. Laboratory testing showed increases white blood count of 14.87 with 80.9% neutrophils and 9.9% lymphocytes and an elevated CRP of 22 mg/l. Infectious workup, included antibodies for Histoplasma, Coccidiodes, Bortonella, Cytomegalovirus, Epstein-Barr virus, mycoplasma, antigen for Blastomyces and Histoplasm, and cultures for bacteria, fungi and mycobacterium, all of which was negative. Chest computed tomography (CT) demonstrated a 2.3 cm round mass in the right upper lobe (RUL) associated with enlarged hilar lymph nodes figure1. During flexible bronchoscopy, which showed a circumferential mass in the anterior segment of the RUL figure1, tissue was obtained. Histopathologic examination revealed features of low-grade neuroendocrine tumor with positive staining for synaptophysin and chromogranin, consistent with carcinoid. Discussion Bronchial carcinoid tumors are among the rarest pediatric tumors, accounting for less than 0.1 % of all malignant tumors in childhood. Our case adds to the limited pediatric literature by illustrating an uncommon presentation of pulmonary carcinoid tumor that initially mimicked an infectious process. Furthermore, pediatric carcinoid tumors are most often detected after prolonged respiratory symptoms or recurrent pneumonia. In contrast, in our patient, the tumor was discovered following a brief, nonspecific illness, making this presentation distinctly unusual. This presentation is atypical compared with previously reported pediatric carcinoid cases, in which diagnostic delays often occur due to recurrent pneumonia or persistent cough before the tumor is discovered. The acute, systemic presentation in our case without preceding chronic pulmonary symptoms, highlights an under-recognized clinical variant that can mimic infection. This scenario underscores the diagnostic challenge when carcinoid tumors present with systemic rather than airway symptoms. Early imaging and bronchoscopy play a critical role in achieving timely diagnosis and guiding appropriate management to avoid unnecessary delays. This abstract is funded by: None
Athwani et al. (Fri,) studied this question.