Acute respiratory symptoms are not always a common pediatric respiratory disease: a clinical case report

Background: Respiratory symptoms caused by viral or bacterial agents are highly prevalent among pediatric patients and represent one of the leading causes of visits to the emergency department. Children with asthma or atopic conditions exhibit an increased susceptibility to respiratory infections and often experience a more prolonged disease course compared to those without such conditions. However, various other pathologies can present with respiratory symptoms that mimic infectious or allergic etiologies, necessitating a thorough differential diagnosis. Case report: We report a case of a 5-year-old child with asthma and allergic rhinitis who presented to the emergency department with nasal congestion, cough, hypoxemia (SpO₂ 77%), tachypnea (respiratory rate 43/min), tachycardia (heart rate 129/min), pallor, perioral cyanosis, and intercostal retractions. Physical examination revealed erythematous nasal and oropharyngeal mucosa with white exudates, decreased breath sounds, and the presence of bilateral fine crackles with a peculiar character, featuring an unusually high-pitched tone not observed in previous admissions; wheezing and a prolonged expiratory phase were not present. Initial presumptive diagnosis was a viral acute lower respiratory tract infection; supplemental oxygen and inhaled salbutamol were initiated. However, recent exposure to a poorly ventilated, chlorinated indoor pool and brief submersion with possible aspiration led to a revised diagnosis of chlorine-induced chemical pneumonitis. Treatment with prednisone resulted in clinical improvement. The patient was discharged on day three with salbutamol and continued asthma management. Conclusions: Although chlorine is a well-recognized respiratory hazard, there is a relative scarcity of clinical case reports documenting pneumonitis due to chlorine inhalation in pediatric patients. Given that respiratory symptoms are a frequent reason for medical consultations, healthcare providers are often inclined to consider more common respiratory conditions. However, a thorough clinical assessment remains essential, always keeping in mind alternative diagnoses such as chlorine inhalation to ensure accurate identification and appropriate management.