A 12-year-old girl with pneumonia.

This 12-year-old girl was transferred from an outside hospital for treatment of pneumonia. She had been well until 7 days before admission, when she developed what was felt to be cellulitis of her left lower extremity. She was given intravenous clindamycin, and the swelling and erythema improved. However, the following day, she started having respiratory distress, and she was found to have an infi ltrate with a pleural effusion on chest X-ray. Chest tube was placed for drainage, after which computerized tomography (CT) revealed pericardial effusion prompting transfer. Her past medical history was remarkable. She had a similar episode of pneumonia with effusion 7 years earlier that required a chest tube on the left side. She was a 31-week fraternal twin, who had no perinatal complications. At birth, she was noted to have left lower extremity hemihypertrophy. At the time she presented to us, she was 7 inches shorter than her fraternal twin sister and had also been recently diagnosed as having growth hormone defi ciency. Family history was unremarkable. On exam, she was an alert interactive girl who was in mild respiratory distress. Temperature was 102°, pulse 120, respiratory rate 28, blood pressure 120/60. Pulse oximetry was