A Complex Pediatric Case of Pulmonary Vascular Hypertension Following Foreign Body Inhalation, Viral‑Induced Wheeze, Micronutrient Deficiencies, Immune Dysfunction and Colorectal Motility Disorder in a Toddler Simulating Status Asthmaticus

Abstract Pulmonary Vascular Hypertension (PVH) in early childhood is uncommon and often overlooked when children present with acute severe wheeze. We report a complex case of a 2‑year‑old girl with colorectal motility disorder, micronutrient deficiencies, immune dysfunction, and recurrent viral‑induced wheeze who developed sudden severe respiratory distress. Her presentation mimicked status asthmaticus but was ultimately attributed to foreign body aspiration and unrecognised pulmonary vascular hypertension. Delayed diagnosis contributed to prolonged ventilatory instability, with the child responding only to muscle relaxants until the underlying pathology was identified. This case highlights the diagnostic challenges posed by multisystem comorbidities and emphasises the importance of holistic assessment, multidisciplinary collaboration, and awareness of PVH in atypical or refractory respiratory presentations. This manuscript describes an exceptionally challenging and educational case involving a 2‑year‑old girl whose presentation mimicked status asthmaticus but was ultimately attributed to a convergence of foreign body aspiration, viral‑induced wheeze, micronutrient deficiencies, immune vulnerability, and unrecognised pulmonary vascular hypertension. The case highlights the diagnostic complexity created by multisystem comorbidities and illustrates how early assumptions can obscure life‑threatening underlying pathology.