A 6-month-old female infant presented to a local hospital with a 9-day  history of non-productive cough and shortness of breath without  fever. She was admitted at the local hospital for a week and treated  with antibiotics (azithromycin, ampicillin, co-trimoxazole) but did  not respond to antibiotics clinically. She was transferred to our tertiary  hospital owing to unresolving pneumonia. On further inquiry, it was  found that she had had a persistent, non-productive cough since she  was 5 weeks old. 
 According to her mother, she failed to gain weight despite normal  feeding habits. There was no history of loose stools, oedema or cyanosis.  She had been admitted thrice since birth, with main complaints  of cough and difficulty in breathing. Her initial admission was at  5 weeks of life, when she was admitted for 2 weeks with the diagnosis  of bronchiolitis. Her second admission was at 3 months, when she  was diagnosed with pneumonia and managed with antibiotics. Her  third admission was at 5 months, when she was first diagnosed with  pneumonia and later started on treatment for pulmonary tuberculosis  based on clinical presentation and a chest radiograph. 
 The infant was born at term by normal vaginal delivery with a  birthweight of 2 830 g, Apgar score of 9/10 at one minute and 10/10  at 5 minutes. She was retroviral disease-exposed with a negative  HIV-PCR at birth. She missed her immunisations at 10 and 14 weeks  owing to a stock shortage at the local clinic. The patient had been  exclusively formula-fed since birth and was on InfaCare formula at  admission. Solid feeds had not been introduced and her milestones  were appropriate for age. There was no family history of tuberculosis  or asthma. On examination, she looked chronically ill with mild  respiratory distress, and she was on nasal-prong oxygen therapy (2 L/ min). Her vital signs were as follows: respiratory rate, 42 breaths per  minute (tachypnoeic); heart rate, 139 beats per minute (tachycardia);  temperature, 36.7  C (normal); and blood pressure, 88/44 mmHg. The  infant's anthropometric measurements were as follows: weight, 4 kg  (below the third percentile); weight-for-length score, below the third  percentile; and she was failing to thrive. There were no signs of clubbing,  jaundice, oedema, pallor, cyanosis or hypopigmented skin lesions. 
 On examination of the respiratory system there were subcostal and  intercostal recessions with bilateral crepitation and no deformities. The abdomen demonstrated hepatomegaly without splenomegaly.  Examination of the cardiovascular system demonstrated normal  pulses and no murmurs. There were no neurological abnormalities.