Mild Persistent Asthma with Acute Exacerbation, Bronchitis, and Abdominal Pain in a Child: a Case Report

Abstract

Mild persistent asthma in children generally has a favorable clinical course, yet it remains at risk of acute exacerbation, particularly when triggered by respiratory tract infections such as bronchitis. In addition to respiratory symptoms, extrapulmonary manifestations such as abdominal pain may occur and complicate diagnosis because they can mimic an acute abdomen. We report an 11-year-10-month-old girl with a history of asthma since the age of three who presented to the emergency department with shortness of breath that had worsened over the preceding 12 hours, accompanied by productive cough, wheezing, rhinorrhea, and postprandial epigastric pain. There was a family history of atopy, with asthma in the mother and eczema in the father, as well as household exposure to cigarette smoke. Physical examination revealed a respiratory rate of 26 breaths per minute, an oxygen saturation of 93% on room air, and wheezing with minimal rhonchi in both lung fields. Nutritional assessment showed undernutrition, with a weight-for-height of 87%. C-reactive protein, antistreptolysin O, and erythrocyte sedimentation rate were within normal limits, chest radiography showed bronchitis without cardiomegaly, and echocardiography was normal. The patient was diagnosed with mild persistent asthma with a mild–moderate acute exacerbation, bronchitis, and abdominal pain. Management consisted of oxygen, nebulized ipratropium bromide–salbutamol and budesonide, systemic methylprednisolone, mucolytics, antihistamines, and gastric therapy, without antibiotics. On the fourth hospital day, the patient was referred to psychiatry because of restlessness, sleep disturbance, and migratory pain, and was diagnosed with acute stress reaction. The patient improved gradually until the fifth hospital day. This case highlights the importance of a holistic approach in evaluating comorbidities, psychosomatic factors, and non-respiratory manifestations in pediatric asthma exacerbations to prevent misdiagnosis and optimize therapeutic outcomes.