A Cyanotic Infant: Infrequent Presentation of Cow's Milk Protein Allergy

Area of Science:

• Pediatric Gastroenterology
• Allergy Immunology
• Clinical Case Reports

Background:

• Cow's milk protein allergy (CMPA) is a prevalent condition in infants, often presenting with diverse gastrointestinal symptoms.
• Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated allergic reaction that can manifest with chronic or acute symptoms.
• Methemoglobinemia, a condition characterized by elevated methemoglobin levels, can present with cyanosis and gastrointestinal distress.

Observation:

• A three-month-old infant presented with persistent poor weight gain, loose stools, and reduced oral intake over three weeks.
• Physical examination revealed pallor, abdominal distension, and cyanosis, with normal oxygen saturation.
• Laboratory investigations indicated significant methemoglobinemia.

Findings:

• The clinical presentation and laboratory findings led to a suspected diagnosis of FPIES in the context of CMPA.
• The co-occurrence of methemoglobinemia and chronic gastrointestinal symptoms in an infant prompted further investigation.
• This case underscores the diagnostic challenges associated with chronic FPIES, particularly when atypical symptoms like methemoglobinemia are present.

Implications:

• Recognizing the potential association between methemoglobinemia and gastrointestinal symptoms is crucial for early FPIES diagnosis in infants.
• Prompt diagnosis and intervention for FPIES and CMPA can prevent long-term complications related to malnutrition and dehydration.
• This case emphasizes the need for a high index of clinical suspicion to identify rare presentations of common pediatric conditions.