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Pulmonary Nodules, Fever, and Hepatosplenomegaly in a 2-Month-Old Child

Dale E. Wenlund, MD
JAMA. 1966;196(3):276-279. doi:10.1001/jama.1966.03100160126037.
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Dr. George F. Zinninger: These roentgenograms were taken of a 2-month-old white girl, who was admitted to the hospital with a chief complaint of cough of two days' duration and diarrhea of approximately one week. The three siblings at home were all well and the family history was essentially normal. The child was pale and lethargic. Physical examination of the chest was unremarkable, but hepatosplenomegaly was noted. The child's temperature was 103.6 F (39.8 C) rectally. The white blood cell count (WBC) was 16,600/cu mm, with 58% polymorphonuclear leukocytes; the hematocrit reading was 28%. A trace of protein was present in the urine along with 3 to 5 WBC. The findings from a lumbar puncture were normal and a few pneumococci were recovered from the sputum. Roentgenograms (Fig 1) were taken the day of admission. They were interpreted as showing patchy infiltrates in the upper-lung fields along with hepatosplenomegaly. The


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