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P112 Fpies and cd8 + deficiency, pathogenic association or comorbidities
  1. Alina Marilena Lazarescu1,2,
  2. Radmila Costachescu1,2,
  3. Corina Pienar1,2,
  4. Liviu Pop1,2
  1. 1II nd Paediatrics Clinic, University of Medicine and Pharmacy ‘Victor Babes’, Timisoara, Romania
  2. 2II nd Paediatrics Clinic, County Hospital ‘Pius Brînzeu’, Timişoara

Abstract

Introduction FPIES (Food Protein-Induced Enterocolitis Syndrome) is a rare form of food allergy, non IgE mediated, described in the infant and toddler. Contributing factors/triggers are not clearly defined,entering into discussion the allergy to cow milk protein or soy,a deficiency of cell-mediated immunity.

Objective To present a case whose history overlaps FPIES diagnosis.

Case presentation Male patient aged 3 years and 11 months, diagnosed in the neurology service in 2015 with febrile seizures and in 2016 with ‘shape belt’ myodistrophy. Previously hospitalised in the paediatric service, the child showed multiple episodes of acute diarrheal disease, associating severe vomiting and dehydration. Symptomatology appeared after 5 months of age, apparently linked to the consumption of cow’s milk protein. Up to 5 months of age, the child was fed naturally.Episodes of severe diarrhoea and dehydration repeated, having a similar clinical picture, without a clearly defined food trigger. The child presented an unsatisfactory stature-weight development. Clinical status at the time of admission: apathy, adinamy, abdominal pain around the navel, diarrhoea (4 stools in 3 hours time), weakness in stature-weight (G=14 kg, T=100 cm, BMI=14 kg/ sqm, P10). Biological investigations carried excluded: an infectious cause (negative stool, Rotavirus and Laboratory exams carried out excluded an infectious cause – negative stool culture, Rotavirus and Adenovirus negative coproantigens, negative sweat test for cystic fibrosis, as well as negative antibodies for the detection of celiac disease. However, immunophenotyping revealed low levels of CD8 +(half the normal value). The hospital was done balancing electrolyte subsequently induced restricted diet for protein from cow’s milk and soy, with the reintroduction of progressive nutrition and other basic foods: potatoes, wheat, root vegetables, poultry and beef, domestic fruit(apple, pear ). The subsequent evolution was favourable, with normalisation of intestinal transit. The patient was discharged with the recommendation to consult a food diary.

Conclusions FPIES is a clinical syndrome with allergic substrates, non IgE mediated and without well defined biomarkers. The case presented corresponds with observations from the literature. Whatever the etiological substrate is, FPIES represents a maximum emergency.

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