Case 1: Wheezing Unresponsive to Bronchodilators in a 4-month-old Boy

Kristen Borchetta, DO* 1. *Palms West Hospital, Loxahatchee, FL. A 4-month-old African American boy presents with cough and wheezing of 1 week’s duration. His pediatrician had diagnosed bronchiolitis and prescribed nebulized albuterol, but the boy had no improvement. He gradually worsened and developed tachypnea, wheezing, and retractions, so his mother has brought him to the emergency department at a community hospital. He has no history of fever, rhinorrhea, diaphoresis, poor feeding, vomiting, or rash. A chest radiograph shows mild cardiomegaly but is otherwise normal. He is hospitalized and treated with intravenous methylprednisolone and nebulized albuterol. During his hospital stay, he develops tachycardia, which is believed to be due to albuterol. After discontinuing albuterol, clinicians administer nebulized levalbuterol, but there is no improvement in heart rate (HR). After several days of treatment, he continues to have tachycardia and tachypnea, prompting echocardiography, which shows …