Little Danny Lai was having a rough two weeks. The 23-month-old toddler had diarrhoea, low-grade fever and a persistent cough that would not go away.
The gastric flu he seemed to be suffering was exacerbating his asthma, diagnosed just a few months earlier. His breathing sounded like a little whistle was lodged in his windpipe. Danny (whose name has been changed for patient confidentiality reasons) had difficulty breathing, which was consistent with asthma.
When the symptoms surfaced, his mother took him to the family doctor, who prescribed cough suppressants and bronchodilators. But the symptoms persisted. After two weeks, Danny's mother took him to see a paediatrician at Queen Mary's Hospital. She was concerned about the prolonged diarrhoea and fever, and feared her son might suffer a bad asthma attack.
When the paediatrician examined Danny, he expected to hear the wheezing reverberate through the entire chest area. But the doctor was surprised to hear the wheezing only in a localised area.
Danny's symptoms did not seem to add up. No one condition would explain his symptoms, so the paediatrician had to consider other less common possibilities. Having recently encountered another presentation of localised wheezing in a young child, the paediatrician suspected that this was no asthma attack. He investigated the boy's recent history and asked Mrs Lai if her son might have choked on anything recently.
At first, nothing came to mind. Then she remembered that Danny had a seemingly very minor choking incident two weeks ago during a meal. He was eating a peanut when he sputtered and coughed for a bit but seemed fine after that.