Hematochezia caused by eosinophilic proctocolitis in a newborn before oral feeding: a case reportReport as inadecuate




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Journal of Medical Case Reports

, 11:160

First Online: 16 June 2017Received: 07 February 2017Accepted: 11 May 2017DOI: 10.1186-s13256-017-1318-z

Cite this article as: Debuf, MJ., Claeys, T., Stalens, JP. et al. J Med Case Reports 2017 11: 160. doi:10.1186-s13256-017-1318-z

Abstract

BackgroundHematochezia is a frequent symptom in early infancy. However, it occurs very rarely within the immediate neonatal period, and its occurrence before any oral intake is particularly rare. Because of the -congenital- presentation of hematochezia in our patient, we initially considered our case to be a non-classical, potentially severe type of food protein-induced allergic proctocolitis. This diagnosis needs to be confirmed by an abnormal oral challenge test once the hematochezia has disappeared. If such a challenge cannot demonstrate an allergic origin, then the etiology of the hematochezia could be a neonatal transient eosinophilic colitis. Only two similar cases have been described so far.

Case presentationWe report the case of a black baby boy of African origin born at 36 weeks 5 days of gestational age who presented with massive hematochezia immediately after birth. A rectosigmoidoscopy revealed a severe inflammation associated with diffuse eosinophilic infiltration on biopsy. His clinical outcome was favorable after introduction of an amino acid formula diet. We initially considered our case to be a non-classical, potentially severe type of food protein-induced allergic proctocolitis but reintroduction of standard formula milk at the age of 3 months was successful. So, our patient is the first newborn in Europe who fits the diagnosis of -neonatal transient eosinophilic colitis.-

ConclusionsWe discuss the possible etiology of -congenital- eosinophilic inflammation of the distal colon and conclude that hematochezia in well-looking neonates, in the absence of negative challenge tests later on, is more likely to be a neonatal transient eosinophilic colitis than an allergic proctocolitis. This new entity could be more frequent than previously thought, changing our medical care strategies for this kind of neonatal symptom.

KeywordsHematochezia Transient eosinophilic colitis Newborn baby Gut AbbreviationsCCL11Human gene encoding for the C-C motif chemokine 11 = eosinophil chemotactic protein and eotaxin-1

CMPCow’s milk protein

CXCL13Human gene encoding for the chemokine ligand 13 = B lymphocyte chemoattractant or B cell-attracting chemokine 1

FPIAPFood protein-induced allergic proctocolitis

IgImmunoglobulin

ILInterleukin

INRInternational normalized ratio

PCRPolymerase chain reaction

RASTRadioallergosorbent tests

TNF-alphaTumor necrosis factor-alpha.





Author: Marie-Julie Debuf - Tania Claeys - Jean-Philippe Stalens - Luc Cornette

Source: https://link.springer.com/







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