Recurrent wheezing is common in infants, most often triggered by respiratory viral infections. When wheezing begins early and persists without symptom-free intervals, it is crucial to first exclude common underlying conditions such as gastroesophageal reflux disease, bronchopulmonary or vascular malformations, and decompensated cardiac disease. Once these etiologies have been ruled out, less frequent disorders—most notably cystic fibrosis—should be considered. Through this case report, we aim to highlight the diagnostic and management challenges of cystic fibrosis in our setting. A 4-month-old infant was hospitalized for recurrent wheezing and dyspnea without symptom-free intervals. Clinical examination revealed severe respiratory distress with diffuse wheezing, along with growth faltering (–3 SD). Chest X-ray demonstrated perihilar atelectasis, bronchial wall thickening in the left lower lobe and the right apical basal segment, and left-sided thoracic hyperinflation and chest CT angiography showed bilateral pneumonia. Immunological investigations were unremarkable. A sweat chloride test, performed twice, confirmed markedly elevated chloride concentrations. The patient showed a favorable clinical evolution following treatment with antibiotic therapy, pancreatic enzyme replacement, vitamin supplementation, and respiratory physiotherapy. In the absence of systematic neonatal screening in our context and to prevent severe and fatal complications, cystic fibrosis should be considered in any case of persistent wheezing in an infant.
Merroun et al. (Tue,) studied this question.