Case Report: Severe asthma following earthquake-related inhalational exposure in a child.

BACKGROUND: The 2023 Kahramanmaraş earthquakes in Türkiye generated massive quantities of respirable dust containing silica, heavy metals, and fungal spores. Children are uniquely vulnerable to disaster-related respiratory injury, yet detailed clinical characterization of pediatric survivors with extreme exposure remains limited. CASE PRESENTATION: A 5-year-old girl presented to a U.S. community health center with progressive cough and dyspnea eight days after immigrating from Türkiye. She had been trapped under earthquake rubble for three days two years prior, during which her father died. Over five months, she required five hospitalizations for recurrent hypoxemic respiratory failure with oxygen saturations as low as 70%. CT chest demonstrated diffuse bronchial wall thickening, intraluminal debris, and air trapping. Laboratory evaluation revealed markedly elevated total IgE (1,664 kU/L) with a negative comprehensive respiratory allergen panel and peripheral eosinophilia (10%), while extensive infectious and alternative diagnostic workup was negative. Stepwise escalation to GINA Step 4-5 triple controller therapy (ICS-LABA, LAMA, LTRA) failed to prevent hospitalizations, with two admissions precipitated by medication access lapses. The patient was subsequently lost to follow-up. CONCLUSIONS: Prolonged earthquake rubble entrapment during early childhood may contribute to the development of severe asthma with non-allergen-specific IgE elevation and eosinophilia, compounded by virus-triggered exacerbations, immigration-related medication access barriers, and psychological trauma. Biologic therapy and systematic respiratory surveillance of pediatric earthquake survivors warrant consideration.