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Protein-losing enteropathy in an infant with severe atopic dermatitis

Yuji Fujita1, Kohei Nomura2, Shigemi Yoshihara2

  • 1Department of Pediatrics, Dokkyo Medical University, Shimotsuga, Tochigi, Japan fujitay@dokkyomed.ac.jp.

BMJ Case Reports
|April 23, 2021
PubMed

Insights

Severe atopic dermatitis (AD) can cause protein-losing enteropathy (PLE). This case highlights the importance of considering PLE in infants with severe AD and low protein levels, even after eczema treatment.

Area of Science:

  • Pediatric Dermatology
  • Gastroenterology
  • Clinical Case Study

Background:

  • Severe atopic dermatitis (AD) is a chronic inflammatory skin condition.
  • Hypoproteinaemia is a potential complication of severe AD.
  • Protein-losing enteropathy (PLE) is characterized by excessive protein loss through the gastrointestinal tract.

Observation:

  • A 7-month-old infant with severe AD, untreated with topical corticosteroids due to familial steroid phobia.
  • Infant presented with decreased feeding, diarrhea, reduced urine output, and vomiting.
  • Despite initial improvement of eczema with topical corticosteroids, persistent hypoproteinaemia, oliguria, and worsening edema were noted.

Findings:

  • Serum albumin scintigraphy confirmed protein-losing enteropathy (PLE) in the distal duodenum.
  • Treatment with systemic prednisolone and albumin resolved PLE symptoms and prevented relapse.
  • This case represents one of the few reported instances of PLE associated with AD in infancy.

Implications:

  • PLE should be considered in the differential diagnosis of infants presenting with severe atopic dermatitis and persistent hypoproteinaemia.
  • Early recognition and management of PLE are crucial in pediatric patients with severe AD.
  • This case underscores the complex interplay between severe skin inflammation and gastrointestinal dysfunction in infants.

Keywords:
dermatologypaediatrics

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