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• W3081159611 abstract "A 2-year-old girl, fed with a goat milk-based formula, presented to our clinic with progressively puffy eyes over 2 weeks. Her mother reported no fever, cardiovascular symptoms, or gastrointestinal symptoms. The girl had been born at a gestational age of 28 weeks, with a birth weight of 890 g (29th percentile) and a birth length of 32 cm (6th percentile). Her weight was 10.5 kg (34th percentile), and her height was 81.4 cm (15th percentile). Periorbital pitting edema and facial pallor were noted (Figure 1). There was no obvious pitting edema in the upper and lower extremities. Laboratory studies revealed a microcytic anemia (4.4 g/dL of hemoglobin with mean corpuscular volume of 44 fL), hypoproteinemia (1.9 g/dL of albumin [reference, 3.5-5.0]; 3.0 g/dL of total protein, [reference 6.0-8.0]), and iron deficiency (<1 ng/mL of ferritin; reference, 10-60 ng/mL). Other laboratory findings, including those of heart, liver, and kidney function, were normal. Urine analysis showed no proteinuria. Stool examination indicated a positive occult blood test result and elevated alpha-1 antitrypsin level (27.4 mg/g; reference, 0-2.95 mg/g). We performed an endoscopy with biopsy (Figure 2); histology demonstrated increased eosinophils in the lamina propria and the epithelium (Figure 3). Eosinophilic gastroenteritis with protein-losing enteropathy and iron deficiency anemia were diagnosed.Figure 2Colonoscopy showing erythematous change and multiple nodules.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Histology demonstrating increased eosinophils in the lamina propria and the epithelium of the gastrointestinal tract (more than 20 eosinophils per high-power field).View Large Image Figure ViewerDownload Hi-res image Download (PPT) We eliminated the goat milk-based formula from the patient's diet and changed to an amino acid-based formula. She also received oral iron replacement treatment. Within 1 month, her swollen eyes resolved and her anemia and hypoproteinemia improved. Eosinophilic gastroenteritis is an inflammatory disorder.1Hogan S.P. Mishra A. Brandt E.B. Foster P.S. Rothenberg M.E. A critical role for eotaxin in experimental oral antigen-induced eosinophilic gastrointestinal allergy.Proc Natl Acad Sci USA. 2000; 97: 6681-6686Crossref PubMed Scopus (146) Google Scholar Potential allergens, such as milk, can cause eosinophilic infiltration in the mucosa, muscle, and serosa layer. Patients may present with various gastrointestinal symptoms, including abdominal pain, nausea, vomiting, dysphagia, diarrhea, intestinal obstruction, and ascites.2Guajardo J.R. Plotnick L.M. Fende J.M. Collins M.H. Putnam P.E. Rothenberg M.E. Eosinophil-associated gastrointestinal disorders: a world-wide-web based registry.J Pediatr. 2002; 141: 576-581Abstract Full Text Full Text PDF PubMed Scopus (144) Google Scholar The integrity of the mucosa can change, resulting in increased serum protein and iron loss in the lumen, which leads to edema and anemia.3Klein N.C. Hargrove R.L. Sleisenger M.H. Jeffries G.H. Eosinophilic gastroenteritis.Medicine (Baltimore). 1970; 49: 299-319Crossref PubMed Scopus (560) Google Scholar Patients may benefit from a diet that eliminates specific food antigens and an amino acid-based formula.4Kliewer K.L. Cassin A.M. Venter C. Dietary therapy for eosinophilic esophagitis: elimination and reintroduction.Clin Rev Allergy Immunol. 2018; 55: 70-87Crossref PubMed Scopus (12) Google Scholar" @default.
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• W3081159611 date "2021-01-01" @default.
• W3081159611 modified "2023-10-16" @default.
• W3081159611 title "Puffy Eyes and Pale Face" @default.
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• W3081159611 doi "https://doi.org/10.1016/j.jpeds.2020.08.050" @default.
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