Drug-induced enterocolitis syndrome in children: report of two cases and a literature review.

Murat Özer, Erhan Bahadır, Bahri Can Duran, Caner Aytekin, Serap Özmen
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Abstract

Background: Drug-induced enterocolitis syndrome (DIES) is a recently defined clinical entity, first described in 2014. DIES is a hypersensitivity reaction with non-IgE mechanisms involving the gastrointestinal tract, occurring 1 to 4 hours after drug ingestion. Antibiotics are most commonly responsible, particularly amoxicillin or amoxicillin / clavulanic acid (AMX/CL). The main criterion is recurrent, often uncontrollable vomiting occurring 1-4 hours after drug ingestion, without classic IgE-mediated allergic symptoms such as cutaneous or respiratory reactions. To the best of our knowledge, 10 pediatric cases of DIES have been described in the literature.

Case presentations: A 4-year-old male and a 14-year-old male presented to our pediatric allergy clinic with a suspected hypersensitivity reaction to AMX/CL, and their specific IgE tests for penicillin G and penicillin V were negative. The younger patient was also tested for specific IgE against amoxicillin and ampicillin, which were also negative. Skin prick tests and intradermal test with AMX/CL were negative in both patients, but oral provocation testing with AMX/CL resulted in abdominal pain, vomiting and lethargy, confirming the diagnosis of DIES.

Conclusions: DIES should be considered in patients presenting with vomiting and lethargy following drug ingestion, particularly when IgE-mediated allergies have been ruled out. Early recognition and appropriate management, including drug provocation testing in a controlled setting, are crucial to ensure optimal patient outcomes. By presenting these two rare cases, we aim to raise awareness and deepen the understanding of DIES among healthcare professionals, which could contribute to earlier diagnosis and better patient outcomes.

儿童药物性小肠结肠炎综合征:两例病例报告和文献综述。
背景:药物性小肠结肠炎综合征(DIES)是一种新近定义的临床实体,于2014年首次被描述。死亡是一种非ige机制的超敏反应,涉及胃肠道,发生在药物摄入后1至4小时。抗生素是最常见的原因,特别是阿莫西林或阿莫西林/克拉维酸(AMX/CL)。主要标准是在服药后1-4小时出现复发性、经常无法控制的呕吐,无典型的ige介导的过敏症状,如皮肤或呼吸反应。据我们所知,文献中描述了10例小儿死亡病例。病例介绍:一名4岁男性和一名14岁男性因疑似AMX/CL超敏反应来到我们的儿科过敏诊所,他们对青霉素G和青霉素V的特异性IgE检测呈阴性。年轻的患者也进行了对阿莫西林和氨苄西林的特异性IgE检测,结果也为阴性。皮肤点刺试验和AMX/CL皮内试验均为阴性,但AMX/CL口服激发试验导致腹痛、呕吐和嗜睡,证实了DIES的诊断。结论:在药物摄入后出现呕吐和嗜睡的患者应考虑死亡,特别是当ige介导的过敏已被排除时。早期识别和适当管理,包括在受控环境中进行药物激发试验,对于确保最佳患者结果至关重要。通过介绍这两个罕见的病例,我们旨在提高医疗保健专业人员对死亡的认识和理解,这可能有助于早期诊断和更好的患者预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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