A Report of Two Patients with Food Protein-induced Enterocolitis Mimicking Bartter Syndrome
Abstract
Food protein-induced enterocolitis syndrome (FPIES), is a non-IgE mediated food allergy presenting in infants younger than 12 months. Diagnostic delay may occur due to overlapping clinical symptoms with several conditions. Here, we present two cases of FPIES, mistakenly diagnosed and treated as Bartter syndrome. This study aims to emphasize the several features of this syndrome that may mimic other diagnoses and sometimes leading to near-death events due to delay in the diagnosis and improper treatment. The first patient was a 30-month-old boy with multiple episodes of profuse vomiting and diarrhea within 1 hour after breastfeeding, beginning from the first month of life progressing to hypokalemia and metabolic alkalosis at the age of 5 months leading to the diagnosis of Bartter syndrome. The second patient had a history of unremitting diarrhea which had been started soon after his first breastfeeding followed by biliary vomiting on the 7th day of life. He was treated in another hospital for neonatal sepsis, however, without an appropriate response to treatment. To conclude, despite the current belief on the rarity of FPIES, it is a more prevalent disease than expected with various non-specific manifestations imitating other conditions which may result in diagnostic delay and sometimes fatalities. To shed light on the importance of the physicians’ awareness of this syndrome, these two cases are presented here as examples of FPIES imitating other disorders.
2. Baldo F, Bevacqua M, Corrado C, Nisticò D, Cesca L, Declich V, et al. FPIES in exclusively breastfed infants: two case reports and review of the literature. Ital J Pediatr. 2020;46(1):1-6.
3. Sarinho E, Lins MdGM. Severe forms of food allergy. J Pediatr (Versão em Português). 2017;93(14):53-9.
4. Mehr S, Frith K, Barnes EH, Campbell DE, Allen K, Barnes E, et al. Food protein–induced enterocolitis syndrome in Australia: A population-based study, 2012-2014. J Allergy Clin Immunol. 2017;140(5):1323-30.
5. Lee S-Y, Jo C-K, Rha S-H, Kim M-J. Food Protein-induced Enterocolitis Mimicking Necrotizing Enterocolitis in a Premature Infant: Case Report. J Perinatol. 2020;31(3):151-5.
6. Nowak-Węgrzyn A, Chehade M, Groetch ME, Spergel JM, Wood RA, Allen K, et al. International consensus guidelines for the diagnosis and management of food protein–induced enterocolitis syndrome: Executive summary—Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2017;139(4):1111-26.
7. Bingemann TA, Sood P, Järvinen KM. Food protein-induced enterocolitis syndrome. Immunol Allergy Clin North Am. 2018;38(1):141-52.
8. Cherian S, Varshney P. Food protein-induced enterocolitis syndrome (FPIES): review of recent guidelines. Curr Allergy Asthma Rep. 2018;18(4):28-36.
9. Leonard SA, Pecora V, Fiocchi AG, Nowak-Wegrzyn A. Food protein-induced enterocolitis syndrome: a review of the new guidelines. World Allergy Organ J. 2018;11(1):4.
10. Petrosino M, Scaparrotta A, Di Filippo P, Attanasi M, Di Pillo S, Chiarelli F, et al. Food protein-induced enterocolitis syndrome in children: what’s known? What’s new. Eur Ann Allergy Clin Immunol. 2018;50(3):99-107.
11. Macraigne L, Allaf B, Buffat C, Spaggiari E, Dimitrov G, Fabre A, et al. Prenatal biochemical diagnosis of two forms of congenital diarrheal disorders (congenital chloride diarrhea and congenital sodium diarrhea): A series of 12 cases. Prenat Diagn. 2021 Mar; 41(4): 434-439. Doi: 10.1002/pd.5878. Epub 2021 Jan 3.
12. Najafi M, Kordi-Tamandani DM, Behjati F, Sadeghi-Bojd S, Bakey Z, Ghayoor Karimiani E, et al. Mimickry and well known genetic friends: molecular diagnosis in an Iranian cohort of suspected Bartter syndrome and proposition of an algorithm for clinical differential diagnosis. Orphanet J Rare Dis. 2019 Feb 13; 14 (1):41. Doi: 10.1186/s13023-018-0981-5.
13. Albareqy AH, Alghamdi FA, Muaibid AFA, Alghamdi ASA, Alghamdi ASA, Alghamdi AA, et al. An Overviewon Bartter Syndromes: Literature Review. Pharmacophore 2020; 11(5): 84-7.
14. Shapiro JM, Balza R, Virk Hundal NK, Hesterberg PE, Zukerberg LR. Case 23-2017: A 9-Day-Old Girl with Vomiting, Acidosis, and Azotemia. N Engl J Med. 2017;377(4):372-83.
15. Khandelwal P, Sabanadesan J, Sinha A, Hari P, Bagga A. Isolated nephrocalcinosis due to compound heterozygous mutations in
Files | ||
Issue | Vol 20 No 5 (2021) | |
Section | Case Report(s) | |
DOI | https://doi.org/10.18502/ijaai.v20i5.7415 | |
Keywords | ||
Bartter syndrome Failure to thrive Food hypersensitivity |
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