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A male infant presented with a 4-day history of fever, cough and worsening chest retractions. He had been treated with oral amoxicillin as an outpatient. Since birth, he has had intermittent noisy and fast breathing, which has acutely worsened. He was breastfed and also received cow’s milk. There was no history of feeding difficulty, vomiting or diarrhoea. He was born at term by uncomplicated vaginal delivery with a birth weight of 2.5 kg. He was the second child of a third-degree consanguineous marriage, with no relevant family history. On admission, his weight was 4.5 kg (below −3 SD), length 60 cm (0 to −2 SD) and weight-for-length below −3 SD. He had tachypnoea with sternal retractions and inspiratory stridor. Breath sounds were equal bilaterally with no bronchial breath sounds. Cardiovascular, abdominal and neurological examinations were normal.