Dieulafoy’s lesion in a paediatric patient on selective serotonin reuptake inhibitors (SSRIs) therapy following short-term treatment with non-steroid anti-inflammatory drugs (NSAIDs)

We present a case of severe upper gastrointestinal bleeding due to Dieulafoy’s lesion in a boy in early adolescence, likely triggered by a short-term treatment of anti-inflammatory drugs (NSAIDs) and ongoing selective serotonin reuptake inhibitor (SSRI) therapy. The patient initially presented with hip pain, fever, vomiting and diarrhoea and was treated with NSAIDs for suspected reactive coxitis. He was later diagnosed with pyomyositis. His history included anxiety disorder treated with SSRIs. Clinical findings revealed elevated inflammatory markers, joint infection with Staphylococcus aureus and acute haematemesis leading to hypovolaemic shock. Emergency gastroscopy identified a Dieulafoy’s lesion, which was successfully treated with endoscopic haemostatic clips. He received blood transfusions and supportive therapy and recovered fully. On discharge, he was prescribed antibiotics, proton pump inhibitors and iron supplements. NSAIDs were contraindicated for future use, and the adverse reaction was reported to the Danish medicines agency.This case highlights the risk of Dieulafoy-related bleeding in children from the short-term use of NSAIDs in combination with ongoing SSRI therapy.