Hematochezia caused by eosinophilic proctocolitis in a newborn before oral feeding: a case report

Abstract

Background: Hematochezia is a frequent symptom in early infancy. However, it occurs very rarely within the immediate neonatal period, and its occurrence before any oral intake is particularly rare. Because of the "congenital" presentation of hematochezia in our patient, we initially considered our case to be a non-classical, potentially severe type of food protein-induced allergic proctocolitis. This diagnosis needs to be confirmed by an abnormal oral challenge test once the hematochezia has disappeared. If such a challenge cannot demonstrate an allergic origin, then the etiology of the hematochezia could be a neonatal transient eosinophilic colitis. Only two similar cases have been described so far.

Case presentation: We report the case of a black baby boy of African origin born at 36 weeks 5 days of gestational age who presented with massive hematochezia immediately after birth. A rectosigmoidoscopy revealed a severe inflammation associated with diffuse eosinophilic infiltration on biopsy. His clinical outcome was favorable after introduction of an amino acid formula diet. We initially considered our case to be a non-classical, potentially severe type of food protein-induced allergic proctocolitis but reintroduction of standard formula milk at the age of 3 months was successful. So, our patient is the first newborn in Europe who fits the diagnosis of "neonatal transient eosinophilic colitis."

Conclusions: We discuss the possible etiology of "congenital" eosinophilic inflammation of the distal colon and conclude that hematochezia in well-looking neonates, in the absence of negative challenge tests later on, is more likely to be a neonatal transient eosinophilic colitis than an allergic proctocolitis. This new entity could be more frequent than previously thought, changing our medical care strategies for this kind of neonatal symptom.

Keywords: Gut; Hematochezia; Newborn baby; Transient eosinophilic colitis.

Fig. 1

Timeline of interventions and outcomes. CMP cow’s milk protein, NICU neonatal intensive care unit, PCR polymerase chain reaction, RAST radioallergosorbent, RX radiography, US ultrasound

Fig. 2

Rectosigmoidoscopy on day 4: View at 2 cm of the anal margin showing a friable, edematous colonic mucosa with nodular lymphoid hyperplasia

Fig. 3

Intestinal biopsy: Biopsy taken on day 4, showing diffuse and massive infiltration of eosinophils in the lamina propria (hematoxylin and eosin staining)