RT Journal Article SR Electronic T1 142 Drug-induced enterocolitis syndrome (DIES) in 6-year old girl JF Archives of Disease in Childhood JO Arch Dis Child FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health SP A60 OP A61 DO 10.1136/archdischild-2021-europaediatrics.142 VO 106 IS Suppl 2 A1 Vrsalović, Renata A1 Škorić, Iva A1 Štefanović, Iva Mihatov A1 Čičak, Biserka YR 2021 UL http://adc.bmj.com/content/106/Suppl_2/A60.2.abstract AB Drug-induced enterocolitis syndrome (DIES) is an uncommon, non-IgE-mediated drug hypersensitivity reaction that can be severe and potentially life-threatening disease. Because of the clinical resemblance with enterocolitis syndrome induced by food proteins (FPIES), DIES is also called ‘FPIES-like’ reaction and similar diagnostic criteria are proposed. We report the case of a 6-year old girl who was admitted to our Department for an oral challenge test with amoxicillin (AMX).She was under the supervision of pulmonologist for recurrent wheezing episodes. During the outpatient- follow up mother reported multiple reactions after the ingestion of amoxicillin +/- clavulanic acid. After the first administration of oral suspension girl developed an erythematous skin rash, abdominal pain followed with an acute episode of repetitive vomiting.Next two administrations were followed with a short period of drowsiness, abdominal pain, repetitive vomiting and severe diarrhea 1-2 hours after drug ingestion. The symptoms spontaneously resolved within 24 hours. During the last reaction parents called an ambulance because of drowsiness and poor general condition after severe vomiting and diarrhea, and girl was treated shortly with intravenous infusion.In the allergy study performed, specific IgE to amoxicillin was negative as well as basophil activation test for Augmentin®.Consecutively, we performed an open 3-step graded oral provocation test with AMX in a hospital setting according to the published guidelines.Approximately 3 hours after receiving the first dose (5 mg) and 1 hour after the second dose (50 mg), she developed severe abdominal pain, nausea and repetitive vomiting, and two hours later she became pale and developed severe diarrhea. During the reaction, she had no cutaneous or respiratory symptoms, and she remained hemodynamically stable. A blood test obtained 1 hour after the onset of the reaction showed normal complete blood cell count. She was parenterally hydrated. Approximately 5-6 hours after onset of symptoms she showed progressive improvement to a complete recovery.Considering previous reactions, laboratory findings and results of the oral challenge test, we suggest that our patient meets the criteria for DIES by amoxicillin. We performed a comprehensive literature search and found three cases of DIES reported in children and one in an adult patient who developed a severe reaction with shock.In our opinion, the clinical awareness on DIES and its potential severity should be improved and it is important to distinguish it from side effect of the drug.