Inadvertent Use of Oral Corticosteroids Leading to Iatrogenic Cushing Syndrome in an Infant with Down Syndrome

Children with down syndrome often have an increased predisposition to recurrent viral related wheezing episodes and other issues like increased oropharyngeal secretions due to hypotonia. Lower airway anomalies such as tracheobronchomalacia and tracheal stenosis are also common. Children with tracheal abnormalities may have a chronic cough or noisy breathing and these conditions are often misdiagnosed as asthma. Here, we present a case report of a six-month-old baby with down syndrome who was misdiagnosed as having bronchial asthma at two months of age because of recurrent episodes of noisy breathing and was prescribed oral steroids which the parents continued in an unsupervised manner. The child presented with increased buccal fat and buffalo hump and was diagnosed as iatrogenic cushing syndrome after investigations. Steroids were gradually tapered and stopped gradually. On follow-up the child had fully recovered and had no signs of hypercortisolism.