Not All Pneumonias Walk the Same Path: An Atypical Case of Pneumonia in an Infant

maintaining SpO₂ of 98% on room air (Fig. 1).Investigations showed positive septic parameters, with C-reactive protein (CRP) 173 mg/L and erythrocyte sedimentation rate (ESR) 73 mm/hour (Table 1).Chest X-ray (CXR) showed features of pneumonia (Fig. 2), and she was started on oxygen via nasal prongs and nebulization.On examination, subcostal retractions (SCR+) and bilateral crepitations were present.Initially, the child was started on injectable piperacillin-tazobactam and, after 3 days, was shifted to injectable IntroductIonLower respiratory tract infections are a leading cause of pediatric morbidity.Mycoplasma pneumoniae commonly affects schoolaged children but is uncommon in children under 2 years of age, accounting for approximately 4% of cases, and severe complications such as necrotizing pneumonia are rare in this agegroup.Rising macrolide resistance has emerged as a significant concern, with macrolide resistance rates in M. pneumoniae increasing from approximately 13.6% to approximately 63% across Asia.This case highlights the growing concern about antimicrobial resistance. case descrIptIonAn 11-month-old female child presented with complaints of fever and cough for 2 weeks, loose stools for 1 week, and hurried breathing for 1 day.She was born of a nonconsanguineous marriage with no antenatal risk factors at term gestation via normal vaginal delivery and weighed 3 kg.No postnatal events were noted.The baby was breastfeeding well and was discharged on day 5 of life.The child was immunized up to age and was developmentally appropriate for age.No significant past history was noted.At 11 months of age, the child presented with the abovementioned complaints.Vital signs showed the child to have increased work of breathing and respiratory distress but 1-