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/m(2). 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.