Protein‐losing enteropathy secondary to collagenous colitis in a 2‐year‐old

Protein‐losing enteropathy associated with collagenous colitis (CC) is a rare but described entity in the adult population. However, literature regarding this in the pediatric population is scarce. Here we describe a 2‐year‐old female who presented with fevers, accompanied by nonbloody, watery diarrhea, and decreased oral intake. Work‐up was significant for severe hypoalbuminemia at 1.5 grams per deciliter (g/dL), pancytopenia, and elevated fecal alpha‐1‐antitrypsin at 1.13 milligrams per grams (mg/g). Gastrointestinal mucosal evaluation was normal endoscopically; however, histology was consistent with CC. She responded to 12‐week treatment with budesonide with resolution of symptoms and laboratory values. At this point, she has not had a recurrence 1 year later.