Food protein‐induced enterocolitis syndrome with pneumatosis intestinalis in an exclusively breastfed infant: A case report and literature review

Abstract

Food protein-induced enterocolitis syndrome (FPIES) is a gastrointestinal, non-IgE mediated, and food hypersensitivity syndrome, and particularly occurs in infants during the introduction of new foods. There is no specific diagnostic test for FPIES, and therefore, diagnosis relies on medical records, symptoms presented, oral food challenges, and symptomatic relief after dietary avoidance. 1 Contrastingly, necrotizing enterocolitis (NEC) is a lifethreatening emergency of the gastrointestinal tract that almost exclusively affects newborns, with 70% of these cases occurring in preterm infants (<36 weeks of gestation). 2 This condition warrants treatment with broad-spectrum antibiotics, bowel rests, inotropes, and fluid support. 3 The diagnosis of FPIES can be challenging, as its clinical manifestations may mimic other diseases such as NEC, leading to misdiagnosis. Symptoms that arise in both conditions include vomiting, abdominal distention, diarrhea, bloody stools, feeding difficulties, lethargy, apnea, and shock. Additionally, in both conditions, diagnostic tests, such as abdominal radiography, may show intestinal dilatation, pneumatosis intestinalis (PI), and portal venous gas. 4 We present a case of FPIES in a 1-month-old, exclusively breastfed male, initially diagnosed with NEC, showing persistent PI on radiography and metabolic acidosis in the venous blood gas test. Our objective was to highlight the diagnostic difficulties associated with FPIES in exclusively breastfed infants. | CLINICAL CASEThe patient was a 1-month-old male, born at 38 + 6 weeks of gestation, with a history of transient tachypnea (requiring oxygen for less than 24 h) and a patent foramen ovale. He had no personal or family history of allergic conditions