Food Protein-Induced Enterocolitis Syndrome (FPIES) in an Infant Presenting with Chronic Diarrhea

Abstract

Acute food protein-induced enterocolitis syndrome (FPIES) is a non-IgE food allergy known to present with repetitive vomiting and/or diarrhea within hours after triggered food ingestion. We herein report an unusual case of FPIES in an infant with chronic diarrhea without obvious vomiting.

A 16-day old Thai infant who had been fed with both breast and cow’s milk, presented with mucous diarrhea and fever. He was initially diagnosed with acute gastroenteritis with moderate to severe dehydration. Initial investigations showed leukocytosis with metabolic acidosis. He was given intravenous antibiotics. His infant formula was changed to lactosefree formula without improvement, so amino acid formula was given. Seven days later, diarrhea improved. An extensively hydrolyzed formula was later introduced without any symptoms at 3 month-old. A graded oral food challenge to cow’s milk was performed at 6 months. The patient had severe repetitive vomiting three hours after start the challenge. The diagnosis of FPIES was confirmed.

Generally, diagnosis of FPIES is often delayed or misdiagnosed because of the nonspecific nature and delayed onset to food ingestion. Chronic diarrhea can be one of the cardinal symptoms of FPIES in infancy, and may actually have “chronic FPIES” that does usually not present with vomiting.