Aspiration pneumonia secondary to GERD (Sandifer syndrome) in a malnourished infant: a case report

Aspiration pneumonia in infancy may arise as a consequence of several underlying medical conditions, among which gastroesophageal reflux disease (GERD) is a notable contributor. Sandifer syndrome (SS), a rare complication of GERD, is characterized by neurological manifestations secondary to reflux. Atypical clinical presentations commonly contribute to delayed recognition of the condition. When a malnourished infant presents with odd movements and breathing issues, SS should not be overlooked - even in early infancy.

We discuss the case of a 3-month-old female newborn from Korangi, Karachi, who came to the hospital with a brief history of fever and trouble breathing. Clinical examination found evidence of failure to thrive, severe malnutrition, and impaired respiratory function. A barium swallow and imaging studies confirmed Grade II GERD with evidence of aspiration. Electroencephalography was performed and showed results indicative of SS. The patient demonstrated a positive response to conservative treatment, which consisted of intravenous antibiotics and anti-reflux medication.

This case highlights the need to recognize atypical GERD presentations in infants. Dystonic posture in SS may mimic seizures, delaying diagnosis. Early recognition avoids unnecessary neurological workups. GERD treatment resolves both gastrointestinal and motor symptoms. Missed cases may lead to aspiration and developmental delays. Clinical suspicion, feeding history, and posture around meals aid diagnosis. Timely management helps prevent complications.

SS should be suspected in infants exhibiting breathing difficulties and poor weight gain. A coordinated, multidisciplinary strategy that involves early contact with gastrointestinal specialists is essential for getting the best potential outcomes.