A case of Cushing ulcer in an 8-month-old patient with medulloblastoma

Area of Science:

• Pediatric Oncology
• Gastroenterology
• Neurosurgery

Background:

• Medulloblastoma is a common pediatric brain tumor.
• Cushing ulcers are stress-induced gastric ulcers often associated with central nervous system lesions.
• Corticosteroids are frequently used in neuro-oncology but can increase gastrointestinal risks.

Observation:

• An 8-month-old boy with medulloblastoma received dexamethasone preoperatively.
• The infant developed melanotic stools postoperatively, indicating gastrointestinal bleeding.
• Endoscopic evaluation revealed two duodenal ulcers.

Findings:

• The patient presented with a Cushing ulcer, a rare complication in infants with medulloblastoma.
• Stress ulcer prophylaxis was insufficient to prevent ulceration during corticosteroid therapy.
• Surgical repair of the duodenal ulcers was necessary.

Implications:

• This case highlights the critical need for vigilant gastrointestinal monitoring in infants with brain tumors receiving corticosteroids.
• It underscores the potential for severe gastrointestinal complications like Cushing ulcers in this vulnerable population.
• Further research may be warranted to optimize ulcer prophylaxis strategies in pediatric neuro-oncology patients.