Protein-losing enteropathy in an infant with severe atopic dermatitis

Abstract

Severe atopic dermatitis (AD) may lead to various complications such as hypoproteinaemia. We describe the case of a 7-month-old male infant with severe AD complicated with protein-losing enteropathy (PLE). He was diagnosed with AD at 2 months of age; however, because of familial steroid phobia, topical corticosteroids were not administered. At 7 months of age, he was admitted to our hospital for decreased feeding, diarrhoea, reduced urine volume and recurrent vomiting. Class 3 topical corticosteroid treatment was initiated. On day 3, eczema had almost resolved. However, serum protein levels had not improved; oliguria persisted and oedema worsened. Serum albumin scintigraphy revealed radioisotopes in the distal duodenum, leading to PLE diagnosis. Systemic prednisolone and albumin were administered, with no PLE relapse after discontinuation. To our knowledge, only two infant PLE cases associated with AD were reported to date. PLE should be considered in patients with severe AD and persistent hypoproteinaemia.

Keywords: dermatology; paediatrics.

Figure 1

Skin findings at the time of admission. (A) Erythema, scratches and bleeding are scattered on the head. (B) Erythemas are observed on precordium and right elbow joint. (C) Erythemas are observed on the knee joint and thigh.

Figure 2

Growth chart of the patient. He was diagnosed with AD at the age of 3 months. At the time of admission at the age of 7 months, significant growth failure was observed. After treatment of AD and PLE, he has been steadily catching up. AD, atopic dermatitis; ADM, admission; PLE, protein-losing enteropathy.

Figure 3

Abdominal ultrasonography of an infant with atopic dermatitis, who developed protein-losing enteropathy, showing ascites, small intestinal dilatation, intestinal wall thickening and decreased intestinal peristalsis.

Figure 4

^99mTc-human serum albumin scintigraphy showing radioisotopes in the distal duodenum (arrow) at 1 hour.

Figure 5

Post-admission disease course. TC application immediately improved eczema; however, hypoalbuminaemia persisted. Oliguria, oedema and body weight increased (from 5.8 to 7.0 kg on day 4). Systemic prednisolone and albumin were administered from day 4. Hypoalbuminaemia and oedema resolved gradually, and the patient was discharged on day 19. TC, topical corticosteroid.