Overt Upper Gi Bleed in an Immunocompetent 1 Year Old, Case Report

Background and aims: Severe gastrointestinal bleeding is uncommon in the pediatric population, and it is a red flag until proven otherwise. Early initiation of resuscitation and appropriate treatment with an etiopathogenic impact is warranted in a child with significant blood loss.

Aims: Pseudomonas aeruginosa septicemia in an immunocompetent child, can present with unexpected signs like upper gastrointestinal bleed, as a sequela of the infection. Evidently, the mortality rate for sepsis is up to 60%.

Methods: We present the case of a 1 year 9-month-old girl who presented to the Emergency Department for the first time with coffee ground vomitus, diarrhea, melanic stool, and fever. She has 3 prior visits to a general practitioner. Shortly after admission, the child was intubated in view of a drop in her conscious level, sudden onset of squint, and expanding right eye subconjunctival hemorrhage.

Results: The child remained critical, became bradycardic, desaturated despite being mechanically ventilated, and subsequently went into cardiorespiratory arrest. Early fluid resuscitation, early airway protection, and adequate antibiotic coverage were established. CPR was commenced for 25 minutes with an adequate amount of fluids resuscitation and advanced life support. Biological: Fulminant hepatitis severe hepatotoxicity, coagulation disorders, and inflammatory tests were positive. Unfortunately, the escalation was unfavorable. The blood culture revealed Pseudomonas Aeruginosa.

Conclusions:

Severe sepsis is solely a clinical judgment, supported by laboratory findings. Early recognition is ultimately the key to a good prognosis. Despite being immunocompetent and fully vaccinated, she developed full-blown sepsis complicated with DIVC and eventually arrested. We believed that this occurred due to the germ’s extensive metabolic diversity and failure of recognizing the critical sign of sepsis.