Hemorrhagic Gastritis from Topical Isopropanol Exposure

Abstract

OBJECTIVE: To report the occurrence of hemorrhagic gastritis after topical isopropanol application in an infant. CASE SUMMARY: A 2-year-old Hispanic boy developed coffee-ground emesis during emergency department evaluation for lethargy and fever. After an initial inconclusive workup for sepsis, further history revealed an isopropanol rubdown for fever reduction. Isopropanol concentrations and acetone metabolites were elevated, the patient recovered with supportive therapy, and other causes for hemorrhagic gastritis were excluded. DISCUSSION: Isopropanol sponge bathing is commonly used as a home remedy for infants with fever. Topical absorption of isopropanol has previously been reported to cause mental status changes, ketosis, and metabolic acidosis. We report a case of hemorrhagic gastritis as a complication of topical isopropanol absorption in a febrile infant. An objective causality assessment revealed that the adverse event was probably caused by the isopropanol. Previous reports of pediatric isopropanol poisoning and its management are discussed. CONCLUSIONS: Severe morbidity from topical isopropanol exposure may occur in young children.