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[Development of a perforated peptic ulcer in a child during high dose prednisolone treatment]

Kirstine Moll Harboe1, Helle Midtgaard, Vibeke Wewer

  • 1Børneafdelingen, Hvidovre Hospital, Kettegård Allé 30, Hvidovre.

Ugeskrift for Laeger
|September 26, 2012
PubMed

Insights

Proton pump inhibitor prophylaxis is not standard for children on high-dose steroids. A six-year-old developed a perforated peptic ulcer, highlighting the need for vigilance and considering PPIs for abdominal symptoms in this population.

Area of Science:

  • Pediatric Gastroenterology
  • Gastrointestinal Surgery
  • Pharmacology

Background:

  • Perforated peptic ulcers are rare in pediatric populations.
  • Routine proton pump inhibitor (PPI) prophylaxis is not standard for children receiving high-dose corticosteroid therapy.
  • High-dose steroids are frequently used in pediatric conditions like nephrotic syndrome.

Observation:

  • A six-year-old child with nephrotic syndrome on high-dose prednisolone presented with atypical symptoms.
  • Initial presentation did not strongly suggest an ulcer.
  • The child subsequently developed peritonitis, necessitating surgical intervention.

Findings:

  • Surgery revealed a perforated peptic ulcer in the stomach.
  • The case underscores the potential for serious gastrointestinal complications even with uncharacteristic symptoms.
  • Delayed diagnosis was attributed to the unusual presentation in a pediatric patient.

Implications:

  • This case suggests considering PPI prophylaxis in children on high-dose steroids who develop abdominal symptoms.
  • Early recognition and intervention are crucial for managing potential peptic ulcer disease in this vulnerable group.
  • Further research may be warranted to define optimal prophylaxis strategies for pediatric patients on long-term, high-dose corticosteroids.

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