<![CDATA[Children with Down syndrome (DS) demonstrate increased vulnerability to severe respiratory infections due to anatomical, immunological, and physiological vulnerabilities. This case report examines the rapid progression of pneumonia in an 8-year-old child with DS, highlighting critical challenges in managing respiratory failure in this population. Methods: A retrospective case report analysis was conducted at a secondary hospital in Surabaya, Indonesia, involving comprehensive review of medical records, laboratory findings, radiological examinations, and clinical progression of an 8-year-old boy with DS who presented with severe community-acquired pneumonia. Results: The patient presented with a 10-day history of fever, productive cough, and dyspnea. Initial assessment revealed tachypnea (36 breaths/min), hypoxemia (SpO? 89%), and bilateral infiltrates on chest radiography. Despite normal leukocyte count, elevated CRP (24.3 mg/L) and thrombocytosis (589 × 10³/µL) indicated significant inflammation. Management with high-flow nasal cannula oxygenation, empirical antibiotics (ceftriaxone and azithromycin), bronchodilators, and intravenous fluids resulted in clinical improvement within 72 hours, with discharge on the sixth day. Discussion: This case underscores how common respiratory infections can rapidly deteriorate in children with DS due to airway abnormalities, immune dysfunction, and neuromuscular hypotonia. Early recognition of hypoxemia as a warning sign and timely multidisciplinary intervention are crucial to prevent respiratory failure. Preventive strategies including optimized vaccination and caregiver education are essential components of comprehensive care.]]>
