Background: Recurrent wheezing (RW) is a frequent cause of hospitalization in children, with a broad range of severity. It can sometimes lead to respiratory failure, requiring ventilatory support in 5–10% of cases. Gastrointestinal bleeding (GIB) is not a common direct complication of RW, but it is a serious one. Case Presentation Summary: A 9-month-old male infant with a history of RW was admitted to a level II hospital due to an exacerbation complicated by pneumonia, with progressive deterioration and the need for ventilatory support, leading to admission to intensive care (IC). Prior to transfer, the patient experienced three episodes of hematochezia, requiring red blood cell transfusions (hemoglobin 5.3 g/dL), volume resuscitation, and intubation for stabilization. On IC admission, the patient was in a fair general condition, pale, tachypneic, with scattered wheezing and crackles on pulmonary auscultation. Laboratory tests showed normal platelets and coagulation. Abdominal ultrasound and computerized tomography scans revealed no abnormalities. Upper gastrointestinal endoscopy revealed two extensive gastric and duodenal ulcers without active hemorrhage. During hospitalization, the patient had three additional episodes of GIB, causing hemodynamic instability. Follow-up endoscopy showed healing of the ulcers. A detailed clinical history revealed that the child had received repeated doses of betamethasone, initiated by the mother in response to mild respiratory symptoms. The patient improved progressively and was discharged on day 40. Outpatient follow-up with gastroenterology and rehabilitation medicine was arranged, and no new GIB episodes have occurred since discharge. Learning Points Discussion: This case highlights the potential severity of upper gastrointestinal bleeding and the importance of airway stabilization, a systematic ABCDE approach, and early use of intravenous proton pump inhibitors (PPIs) in the worst cases. It emphasizes the critical role of a thorough clinical history in identifying risk factors such as fasting, dehydration, and corticosteroid use. Moreover, it underscores the importance of enhancing health literacy to discourage self-medication and foster more rational prescribing practices among healthcare professionals.
Cunha et al. (Thu,) studied this question.