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Allergic eosinophilic gastroenteritis in a boy with congenital duodenal obstruction
1Department of Internal Medicine, Chai Yi Veterans Hospital, Taiwan, ROC.
Insights
Eosinophilic gastroenteritis (EG) is a rare allergic disease. This case highlights EG in an infant with congenital duodenal obstruction, suggesting a complex interplay between allergy and gastrointestinal conditions.
Area of Science:
- Pediatric Gastroenterology
- Allergy and Immunology
Background:
- Eosinophilic gastroenteritis (EG) is a rare, allergy-related gastrointestinal disorder, infrequently diagnosed in early childhood.
- Congenital duodenal obstruction is a condition affecting the small intestine present from birth.
Observation:
- A case report of a 1 year 4 month old boy with congenital duodenal obstruction who subsequently developed EG.
- Diagnostic evaluations included imaging studies and upper gastrointestinal endoscopic biopsy, revealing significant eosinophilic infiltration in mucosal and submucosal layers.
- Cow's milk allergy was suspected due to elevated IgE levels, though definitive confirmation was precluded by the patient's condition.
Findings:
- The patient presented with symptoms suggestive of EG, complicated by gastric perforation and confirmed duodenal stenosis.
- Histopathological examination confirmed EG with eosinophilic infiltration, ruling out parasitic causes.
- Treatment with a semi-elemental formula and oral prednisolone yielded a partial response.
Implications:
- This case underscores the rare co-occurrence of EG and congenital duodenal obstruction in an infant.
- The potential roles of cow's milk allergy as an etiological factor and duodenal obstruction as a predisposing factor in EG remain to be elucidated.
- Further research is needed to clarify the relationship between these conditions and the extent of EG involvement.
Abstract:
Eosinophilic gastroenteritis (EG) is a rare allergy-related disease, especially in early childhood. We present the case of a 1 year 4 month old boy with congenital duodenal obstruction who developed EG. That diagnosis of EG was made by a series of imaging studies and was confirmed by upper gastrointestinal (UGI) endoscopic biopsy studies which showed significant tissue eosinophilia in both mucosal and submucosal layers. No evidence of parasite segment or ova was found in the stool and biopsy specimen. Specific IgE antibodies to milk were estimated to be 2 + (CAP system). Cow's milk allergy was highly suspected but not confirmed by consecutive elimination and challenge tests since the child was too much suffered to be tested. There was partial response to the 2-week treatment with Alfare (semi-elemental formula) and oral prednisolone 1 mg/kg/day. One month after initial examination, perforation of the stomach occurred and exploratory laparotomy disclosed stenosis of the duodenum. Congenital duodenal obstruction was diagnosed based on operative findings and previous sonographic findings. There has been only one report of EG in an infant with congenital duodenal obstruction. The nature of the relationships among cow's milk allergy as a possible etiologic factor, congenital duodenal obstruction as an predisposing factor and EG involvement at both mucosal and submucosal layers remains unclear.