A 2 year old girl with fever, cough, and tachypnoea

A 2 year old girl presented to the accident and emergency department with high grade fever (temperature 39.2oC), cough, tachypnoea (respiratory rate 45 breaths/min), and lethargy. She had been unwell for six weeks with general malaise and intermittent fever. She had also been anorexic for three weeks and had lost about 7% of her body weight. She was born in Australia to parents from the South Pacific Islands. Her routine immunisations were up to date and her past medical history was unremarkable. The patient underwent chest radiography (fig 1⇓). Fig 1 Chest radiograph of a 2 year old girl with high grade fever, cough, and tachypnoea ### Short answers Fig 2 Chest radiograph showing bilateral miliary infiltrates and outlining the cavitating pulmonary lesion in the left lower lobe (arrows)