Intractable diarrhea of infancy

Abstract

A 5-month-old female developed watery diarrhea six to ten times a day, three weeks before admission. The diarrhea later showed streaks of blood and large amounts of mucous. Over those three weeks, there was a 0.7 kilogram weight loss. Changes of feeds to Pedialyte, and later to a soy formula and later still to Nutramigen were of no avail. The presence of reducing sugars and of an acid pH in the baby's stools led to a diagnosis of carbohydrate malabsorption. A small bowel biopsy showed mucosal villous atrophy and infiltration with eosinophils and plasma cells, findings characteristic of intractable diarrhea of infancy. A biopsy of the colon also showed eosinophilic infiltration. The Findings suggested that milk protein allergy had led to mucosal damage and malabsorption and malnutrition. The baby could not tolerate a hypoallergenic, lactose-free formula, even when given in a dilute form by continuous NG feeding. She was given parenteral hyperalimentation for about one month and was gradually reintroduced to enteral feeding.