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One problem case discussed by my old student Six month old baby born out of non consanguineous marriage.  Antenatal natal and post natal period uneventful and her growth and development was normal till 13 days back. Whole event started with running nose low grade fever, which was managed symptomatically.As the cough and dyspnea worsened he was put on antibiotics orally ,later became worse and was referred to him. Patient was admitted in PICU, ventilated.Clinical ,radilogical features suggestive of bronchopneumonia.Blood culture came negative.  Baby responded well. Cirulatory status normal, chest clear. Heart sounds normal,no cardiomegaly, He was stable on minimal settings on room air but could nt be weaned from ventilator There was family history of two siblings died at eight month in similar manner. One boy and one girl. His sensorium normal,eye movement normal pupils normal and facial movement normal. Tone of limbs was on lower side and deep tendon reflexes not e