[CIS PIDD] [cis-pidd] Infant with persistent diarrhea.

[Kobrynski, Lisa]

One of my GI colleagues asked about a patient of theirs and I am not sure this is immunologic, but wondered if anyone else had seen a similar picture.



A 5 month old male with persistent diarrhea (initially with blood) x3 months and a near pan-colitis.  Biopsies have shown excessive eosinophils particularly in cecal region (>100/hpf) along with colitis (stomach and duodenum are normal); however, he has not responded to either exclusive neocate or elecare and currently is requiring HAL supplementation because of poor weight gain and excessive stooling.  Immune workup to this point has shown mildly low IgG = 162 (drawn at 2 months of age) and normal DHR. IgA 14, IgM 41.  A previous short course of steroids had equivocal results. He has not had peripheral eosinophilia, normal ALC and is not currently anemia (He was 2 months ago). Liver enzymes are normal.  He has no skin disease.

Stool cultures for usual pathogens and c diff studies were negative.

He did get two doses of rotavirus vaccine.

I asked them to check rotavirus in the stools.



Any thought?

Thanks

Lisa



Lisa Kobrynski, MD, MPH
Associate Professor of Pediatrics
Marcus Professor of Immunology
Section, Allergy/Immunology

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