Food protein-induced enterocolitis syndrome presenting after necrotizing enterocolitis in a preterm neonate: a case report

Lü, Yan; Zhiqun, Zhang

doi:10.21037/tp-21-9

Cited by 4 publications

(3 citation statements)

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“…However, signs of PI were reported in FPIES [20]. There are several studies documenting a concomitance of NEC, FPIES and PI [21][22][23]. In the research by Kim 6.7% of preterm and 44.7% of term infants with presumed NEC were confirmed to have FPIES [23].…”

Section: Discussionmentioning

confidence: 99%

Food Protein Induced Allergic Proctocolitis with Pneumatosis Intestinalis in SARS-Cov-2 Positive Infant

2023

Ann Case Report

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Pneumatosis Intestinalis (PI), characterized by the presence of submucosal air in the intestinal wall, is an uncommon finding in the pediatric population. Food Protein Induced Allergic Proctocolitis (FPIAP) is a prevalent manifestation of food allergy in children, presenting with bloody stools in otherwise healthy infants. We present a case report of a 5-week-old boy with PI, diagnosed in the course of FPIAP and concurrent COVID-19 infection.The patient was admitted to the hospital due to the occurrence of bright blood in the stool. Subsequent abdominal USG revealed an increasing pneumatosis intestinalis in the ileum and ascending colon. During hospitalization, the patient developed cough, rhinitis, and was tested positive for SARS-CoV-2. The main therapeutic intervention involved a change in feeding from a milk-containing diet to extensively hydrolysed formula, which was followed by a remission of the symptoms and improvement in patient's clinical condition.Pneumatosis Intestinalis still remains an unexplored phenomenon in pediatric patients. Recent observations suggesting an association with common diseases definitely require further investigations to explore its characteristics and proceeding in allergy and viral infections.

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Section: Discussionmentioning

confidence: 99%

Food Protein Induced Allergic Proctocolitis with Pneumatosis Intestinalis in SARS-Cov-2 Positive Infant

2023

Ann Case Report

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“…Therefore, FPIES may be easily misdiagnosed as other diseases, such as gastroenteritis, sepsis, intussusception, NEC, surgical abdomen or inborn errors of metabolism. Especially during the neonatal period, NEC may be considered when a newborn has bloody stools ( 19 , 20 ). Leukocytosis and the intestinal motility outside the lesion area may be the differentiations of FPIES and NEC ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

“…Especially during the neonatal period, NEC may be considered when a newborn has bloody stools (19,20). Leukocytosis and the intestinal motility outside the lesion area may be the differentiations of FPIES and NEC (21).…”

Section: The Clinical Presentations Of Chronic Fpies Are Variable Aty...mentioning

confidence: 99%

The challenging diagnosis of food protein-induced enterocolitis syndrome: A case report series

2022

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Food protein-induced enterocolitis syndrome (FPIES) is a type of non-immunoglobulin E (IgE)-mediated food allergy. However, in addition to vomiting and diarrhea, IgE-mediated skin or respiratory symptoms may be comorbidities in some patients with FPIES. We described four unusual cases of neonates with FPIES, whose clinical presentations were variable and misleading. All patients experienced vomiting, diarrhea or other gastrointestinal symptoms, and three of them developed IgE-mediated food allergy. Case 1 was admitted to the hospital with convulsions and then developed severe sepsis and necrotizing enterocolitis (NEC)-like appearance. Case 2 was wrongly diagnosed with Stevens–Johnson syndrome due to a severe extravasation rash of the skin and mucous membranes and a systemic inflammatory response. There was unexplained cholestasis in case 3, which might be attributed to food allergy. Asymptomatic elevation of C-reactive protein was the only hint at early-stage FPIES in case 4. Moreover, there were increased serum food-specific IgG values in three of the above cases. After eliminating the offending food, all of the above clinical manifestations rapidly improved in the four cases; thus, we believe that the most correct diagnosis in the described four cases was FPIES. This case report series should further draw clinicians’ attention to FPIES with variable and atypical symptoms. The usefulness of IgG levels in identifying the presence of FPIES is uncertain.

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Lactis proteinum

2021

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Lactis proteinumEnterocolitis syndrome following necrotising enterocolitis: case report A 7-day-old male neonate developed enterocolitis syndrome and necrotising enterocolitis (NEC) during treatment with lactis proteinum.The boy was born preterm at 28 weeks of gestation. He had respiratory distress syndrome at birth and received nasal continuous positive airway pressure (nCPAP) for 6 days, and caffeine citrate for apnoea of prematurity. On day of life (DOL) 2 , he was continued on freshly expressed breast milk (EBM) along with preterm formula containing lactis proteinum [Cow's milk protein; dosage not stated]. Feedings were advanced at 10-20 mL/kg/day. On DOL 7, he developed grossly bloody stools, gastric residual, apnoea. Physical examination showed abdominal distention, left abdominal tenderness, and sluggish bowel sounds. Laboratory investigations revealed elevated CRP, decreased WBC count, and positive stool occult blood. An abdominal X-ray demonstrated pneumatosis intestinalis . Subsequently, he became pale and less active, with episodes of tachycardia and hypotension, and required conventional mechanical ventilation, fluid resuscitation and haemodynamic support for normal BP over the next 24 hours. Based on these findings, he was diagnosed with NEC.The boy was treated with piperacillin/tazobactam and vancomycin. Immediately, culture test was found positive Escherichia coli, and vancomycin was stopped. The antibiotic therapy was changed to piperacillin/tazobactam and meropenem for 14 days, and discontinued on DOL 20. He was continued on mechanical ventilation. Over a period of one week, clinical and radiological improvement was noted. On DOL 15, he was again resumed EBM that was well tolerated. On DOL 29, because of insufficient breast milk, he was resumed on enteral feeds with formula containing lactis proteinum. Subsequently, he developed a second episode of bloody stools. His abdomen was soft, not distended, and non-tender, with active bowel sounds. The stool test was positive for occult blood, with normal CRP and WBC count. An abdominal X-ray showed mild thickening of the small bowel, with no evidence of PI, which was consistent with a recurrence of NEC. He was treated with an unspecified antibiotic therapy. Thereafter, his serum CRP and WBC counts remained normal. After three days, he was again started on enteral feeding with expressed breast milk fortified with lactis proteinum. On DOL 46, he experienced third episode of bloody stools. Hence, a diagnosis of food protein-induced enterocolitis syndrome was made secondary to lactis proteinum, and the feeding was stopped. Thereafter, his symptoms disappeared without any bloody stools. He was continued on expressed mother's milk without lactis proteinum after one day of fasting, after which no bloody stools were observed.On DOL 54, during COVID-19 outbreak, the boy was re-initiated on the preterm formula containing lactis proteinum. He again had recurrence of grossly bloody stools with increased eosinophil count. His formula was then changed to hydrolysed f...

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Food protein-induced enterocolitis syndrome presenting after necrotizing enterocolitis in a preterm neonate: a case report

Cited by 4 publications

References 20 publications

Food Protein Induced Allergic Proctocolitis with Pneumatosis Intestinalis in SARS-Cov-2 Positive Infant

Food Protein Induced Allergic Proctocolitis with Pneumatosis Intestinalis in SARS-Cov-2 Positive Infant

The challenging diagnosis of food protein-induced enterocolitis syndrome: A case report series

Lactis proteinum

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