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Severe upper gastrointestinal hemorrhage due to milk protein allergy: A case report
Huan-Huan Jiang1, Qing Tang1, Li Huang1
1Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
Background:
Upper gastrointestinal hemorrhage is a life-threatening manifestation of cow's milk protein allergy (CMPA). We analyze the clinical characteristics of a case of milk protein allergy manifested as severe upper gastrointestinal hemorrhage.
Case Summary:
The hospital admitted a 2-month-old male infant due to "melena for 6 days, hematemesis twice". The main symptom was melena, initially occurring once or twice per day, then gradually increasing to five or six times per day at their peak. During the course of the illness, the infant vomited blood, but there were no reports of vomiting, fever, pale complexion, dyspnea, wheezing, or difficulty breathing. Laboratory tests showed hemoglobin level of 87 g/L, platelet count of 349 × 109/L, and eosinophil percentage of 0.031. Coagulation studies were normal. After avoiding certain foods and feeding with an amino acid formula for 2 weeks, a repeat gastroscopy revealed less bleeding. After six weeks, a positive oral food challenge test confirmed a severe CMPA. At the 4-month follow-up, there was no gastrointestinal bleeding, and the infant was growing and developing well.
Conclusion:
The manifestations of milk protein allergy are diverse and nonspecific, with gastrointestinal bleeding being less common, especially in infants. When infants present with unexplained massive hematemesis, it's critical to investigate the possibility of CMPA.
Insights
Cow's milk protein allergy (CMPA) can cause severe upper gastrointestinal bleeding in infants. Prompt investigation of CMPA is crucial for infants with unexplained hematemesis to ensure proper diagnosis and management.
Area of Science:
- Pediatric Gastroenterology
- Allergology
Background:
- Cow's milk protein allergy (CMPA) can present with severe upper gastrointestinal hemorrhage, a critical condition in infants.
- The diverse and nonspecific symptoms of CMPA often delay diagnosis, particularly when gastrointestinal bleeding is the primary manifestation.
Observation:
- A 2-month-old infant presented with melena and hematemesis, indicative of significant upper gastrointestinal bleeding.
- Initial investigations revealed anemia and a normal coagulation profile; however, symptoms persisted despite dietary modifications.
- A positive oral food challenge confirmed severe CMPA as the underlying cause of the hemorrhage.
Findings:
- Infants with CMPA may exhibit severe gastrointestinal bleeding, including hematemesis and melena.
- Diagnosis of CMPA-related bleeding requires a high index of suspicion and can be confirmed through oral food challenges.
- Early identification and management of CMPA lead to resolution of gastrointestinal bleeding and improved infant outcomes.
Implications:
- This case highlights the importance of considering CMPA in the differential diagnosis of unexplained upper gastrointestinal bleeding in infants.
- Timely diagnosis and appropriate dietary management (e.g., amino acid-based formula) are essential for resolving CMPA-induced hemorrhage.
- Recognizing the less common but severe gastrointestinal manifestations of CMPA is vital for pediatric healthcare providers.
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