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Diagnosis of Food Protein-Induced Enteropathy Based on Gastrointestinal Mucosal Pathology before and after Elimination Diet Therapy: A Case Report

We describe the case of a 1-year-old girl with food protein-induced enteropathy (FPE) that was difficult to diagnose. She was referred to our hospital with a 3-month history of diarrhea, vomiting, and weight loss. Although her diarrhea improved after a few days of fasting, oral intake of elemental d...

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Autores principales: Kakiuchi, Toshihiko, Furukawa, Rie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9503454/
https://www.ncbi.nlm.nih.gov/pubmed/36136084
http://dx.doi.org/10.3390/pediatric14030045
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author Kakiuchi, Toshihiko
Furukawa, Rie
author_facet Kakiuchi, Toshihiko
Furukawa, Rie
author_sort Kakiuchi, Toshihiko
collection PubMed
description We describe the case of a 1-year-old girl with food protein-induced enteropathy (FPE) that was difficult to diagnose. She was referred to our hospital with a 3-month history of diarrhea, vomiting, and weight loss. Although her diarrhea improved after a few days of fasting, oral intake of elemental diets, formula milk, or rice porridge resulted in repeated relapses. The serum IgE level was 1028 IU/mL, and radioallergosorbent tests were positive for milk, casein, alpha-lactalbumin, and other allergens. A histopathology of the duodenal mucosa revealed loss of mucosal villous structure, crypt hyperplasia, crypt apoptosis, and lymphocyte and eosinophil infiltration (<20 eos/hpf) into the lamina propria. After prednisolone (PSL) therapy and the complete removal of cows’ milk and chicken eggs from her diet, the patient’s diarrhea disappeared. Five months after discontinuing oral PSL and complete removal of cows’ milk and chicken eggs, the duodenum exhibited normal mucosal villous structure and well-differentiated ducts. No abnormalities were observed in the egg rechallenge; however, diarrhea recurred after the cows’ milk rechallenge. Thus, histopathologic examination of the gastrointestinal mucosa is useful for diagnosing FPE similar to oral food challenges, and re-evaluation after elimination diet therapy may be beneficial to rule out other diseases.
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spelling pubmed-95034542022-09-24 Diagnosis of Food Protein-Induced Enteropathy Based on Gastrointestinal Mucosal Pathology before and after Elimination Diet Therapy: A Case Report Kakiuchi, Toshihiko Furukawa, Rie Pediatr Rep Case Report We describe the case of a 1-year-old girl with food protein-induced enteropathy (FPE) that was difficult to diagnose. She was referred to our hospital with a 3-month history of diarrhea, vomiting, and weight loss. Although her diarrhea improved after a few days of fasting, oral intake of elemental diets, formula milk, or rice porridge resulted in repeated relapses. The serum IgE level was 1028 IU/mL, and radioallergosorbent tests were positive for milk, casein, alpha-lactalbumin, and other allergens. A histopathology of the duodenal mucosa revealed loss of mucosal villous structure, crypt hyperplasia, crypt apoptosis, and lymphocyte and eosinophil infiltration (<20 eos/hpf) into the lamina propria. After prednisolone (PSL) therapy and the complete removal of cows’ milk and chicken eggs from her diet, the patient’s diarrhea disappeared. Five months after discontinuing oral PSL and complete removal of cows’ milk and chicken eggs, the duodenum exhibited normal mucosal villous structure and well-differentiated ducts. No abnormalities were observed in the egg rechallenge; however, diarrhea recurred after the cows’ milk rechallenge. Thus, histopathologic examination of the gastrointestinal mucosa is useful for diagnosing FPE similar to oral food challenges, and re-evaluation after elimination diet therapy may be beneficial to rule out other diseases. MDPI 2022-09-19 /pmc/articles/PMC9503454/ /pubmed/36136084 http://dx.doi.org/10.3390/pediatric14030045 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Kakiuchi, Toshihiko
Furukawa, Rie
Diagnosis of Food Protein-Induced Enteropathy Based on Gastrointestinal Mucosal Pathology before and after Elimination Diet Therapy: A Case Report
title Diagnosis of Food Protein-Induced Enteropathy Based on Gastrointestinal Mucosal Pathology before and after Elimination Diet Therapy: A Case Report
title_full Diagnosis of Food Protein-Induced Enteropathy Based on Gastrointestinal Mucosal Pathology before and after Elimination Diet Therapy: A Case Report
title_fullStr Diagnosis of Food Protein-Induced Enteropathy Based on Gastrointestinal Mucosal Pathology before and after Elimination Diet Therapy: A Case Report
title_full_unstemmed Diagnosis of Food Protein-Induced Enteropathy Based on Gastrointestinal Mucosal Pathology before and after Elimination Diet Therapy: A Case Report
title_short Diagnosis of Food Protein-Induced Enteropathy Based on Gastrointestinal Mucosal Pathology before and after Elimination Diet Therapy: A Case Report
title_sort diagnosis of food protein-induced enteropathy based on gastrointestinal mucosal pathology before and after elimination diet therapy: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9503454/
https://www.ncbi.nlm.nih.gov/pubmed/36136084
http://dx.doi.org/10.3390/pediatric14030045
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