Respiratory Syncytial Virus: More than just Bronchiolitis

Introduction: Respiratory Syncytial Virus (RSV) is a common cause of lower respiratory tract infections among pediatric patients, especially during the winter months. It is associated with significant morbidity and mortality among young infants, especially those with history of prematurity and cardiac anomalies. We present a case of a 2-year-old previously healthy girl, with RSV bronchiolitis, who developed cardiac arrest secondary to cardiac tamponade. Case Report: 2-year-old, healthy female, presented with fever and a four-day history of cough and worsening respiratory distress. At home, parents reported perioral cyanosis, post-tussive emesis, decreased oral intake and urine output. She tested positive for RSV at an outside hospital prior to our Pediatric Emergency Department arrival. On arrival she was afebrile, tachypneic, tachycardic, with oxygen saturation of 93% on 2 liters/minute nasal cannula. She was in respiratory distress with coarse breath sounds. The remainder of her exam including the cardiac portion was unremarkable. Albuterol trial was not beneficial. She was started on Ceftriaxone, given a bolus and admitted to the pediatric floor. Inpatient workup included an unremarkable CBC and CMP. She received an additional bolus of fluids and continued antibiotic therapy.