Li S, Chen LN, Zhong L. A 7-year-old boy with recurrent cyanosis and tachypnea: A case report. World J Clin Cases 2022; 10(20): 6974-6980 [PMID: 36051109 DOI: 10.12998/wjcc.v10.i20.6974]
Corresponding Author of This Article
Lin Zhong, MD, Attending Doctor, Department of Pediatric Pulmonology and Immunology, West China Second University Hospital of Sichuan University, No. 1416 Chenglong Road, Chengdu 610066, Sichuan Province, China. linca_zhong@163.com
Research Domain of This Article
Pediatrics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jul 16, 2022; 10(20): 6974-6980 Published online Jul 16, 2022. doi: 10.12998/wjcc.v10.i20.6974
A 7-year-old boy with recurrent cyanosis and tachypnea: A case report
Shu Li, Li-Na Chen, Lin Zhong
Shu Li, Li-Na Chen, Lin Zhong, Department of Pediatric Pulmonology and Immunology, West China Second University Hospital of Sichuan University, Chengdu 610066, Sichuan Province, China
Shu Li, Li-Na Chen, Lin Zhong, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu 610066, Sichuan Province, China
Shu Li, Li-Na Chen, Lin Zhong, NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu 610066, Sichuan Province, China
Author contributions: Li S contributed to data collection and analyses and drafted the manuscript; Chen LN contributed to data analyses and critical revision of the manuscript; Zhong L contributed to the conception and design and gave final approval of the manuscript to be published.
Supported bythe Science and Technology Department of Sichuan Province, No. 2020YFS0105; and the West China Second University Hospital of Sichuan University, No. KL036.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lin Zhong, MD, Attending Doctor, Department of Pediatric Pulmonology and Immunology, West China Second University Hospital of Sichuan University, No. 1416 Chenglong Road, Chengdu 610066, Sichuan Province, China. linca_zhong@163.com
Received: October 31, 2021 Peer-review started: October 31, 2021 First decision: December 27, 2021 Revised: January 10, 2022 Accepted: May 13, 2022 Article in press: May 13, 2022 Published online: July 16, 2022
Abstract
BACKGROUND
Brain tumors are the most common solid tumors in children and comprise 25% of all malignancies in children. Common presentations include headache, nausea and vomiting, gait abnormality, papilledema, and epileptic seizure; however, some symptoms can be very insidious, with atypical and misleading manifestations.
CASE SUMMARY
Here, we report a 7-year-old boy who presented with recurrent cyanosis and tachypnea after exercise for 2 years. His body mass index was 26.43 kg/m2. Hepatosplenomegaly, blood gas analysis, biochemical parameters, chest computed tomography scan, and echocardiograph suggested type II respiratory failure, pulmonary heart disease, and mild liver injury. Non-invasive breathing support, antibiotics, and anti-heart failure therapy were given. The patient’s pulse oxygen saturation increased to over 95% when he was awake but dropped to 50%-60%, accompanied by cyanosis, during sleep while receiving high-flow nasal cannula oxygen. Sleep-related breathing disorder was suspected. In the intensive care unit, however, polysomnography was unavailable. Brain magnetic resonance imaging revealed a space-occupying (cerebellum and brainstem) lesion, which was later confirmed to be pleomorphic xanthoastrocytoma by surgery and histopathology by tissue biopsy.
CONCLUSION
When treating patients with cyanosis and tachypnea, a broad differential diagnosis should be considered, including brain tumor.
Core Tip: Brain tumors are the most common solid tumors in children. Common presentations include headache, nausea and vomiting, gait abnormality, and epileptic seizure; however, some symptoms can be insidious and misleading. Here, we report a 7-year-old boy who presented with recurrent cyanosis and tachypnea after exercise for 2 years. Type II respiratory failure, pulmonary heart disease, liver injury, and severe obesity were diagnosed. Cyanosis during sleep (peripheral oxygen saturation dropping to 50%-60%) was observed during hospitalization. Sleep-related breathing disorder was suspected. Brain magnetic resonance imaging revealed a cerebellum and brainstem space-occupying lesion. Subsequent tissue biopsy pathology confirmed brainstem pleomorphic xanthoastrocytoma.
