Fatal hemoptysis in a child with ataxia-telangiectasia: Zeroing down on the rare cause

An 11-year-old girl born of non-consanguineous marriage was brought with a 4-day history of fever, cough, and progressive shortness of breath. The fever was high-grade and continuous, not responding to medications. The cough was associated with scanty whitish expectoration without any hemoptysis. The child had a significant past history of repeated monthly episodes of cold and fever since the age of 5 years, associated with progressive difficulty in walking due to swaying. Her handwriting had also deteriorated over the past 2 years. Her elder sister had similar complaints from the age of 8 years and she was bed-ridden at the age of 14 years. Pulmonary cavitatory lesions and consolidation had been noted on high-resolution computed tomographic scan (HRCT) 6 months back. Considering these lesions and her history of repeated episodes of respiratory infection, she was started on four-drug anti-tuberculosis therapy (ATT) at another institution, which was continued till her present illness. The child, however, had not shown any improvement in her symptomatology, despite the ATT.