PROTEIN–ENERGY MALNUTRITION OF KWASHIORKOR´S TYPE DUE COW'S MILK PROTEIN ALLERGY

Abstract

Enteropathy induced by diet protein is one of the presentation profile of food allergy, and cow's milk protein allergy (CMPA) is the most common cause, occurring frequently in infants. Diagnosis depends on a thorough history associated with a favorable clinical response to the withdrawal of antigen. In this report, a year and eight-month-old patient is admitted to investigate protein-energy malnutrition (PEM) with severe vomiting, bloody diarrhea and significant weight loss since eight months of age. She had breastfeeding during the first month of life, followed by infant formula until fourth month and, since then, full cow's milk. At admission, presented very irritable, crying, angry, dehydrated, with severe weight loss, with color change and brittle hair, edema and hepatomegaly. Laboratory tests showed megaloblastic anemia, leukocytosis and hypoalbuminemia. Diagnostic hypotheses: celiac disease, cystic fibrosis and CMPA. Esophagogastroduodenoscopy with biopsy showed slight increase of intra-epithelial eosinophils in the duodenum and chronic mild esophagitis with rare eosinophil infiltrate. Sweat test was negative. Diagnosis of kwashiorkor PEM triggered by CMPA was made and it was started hydrolyzed protein diet with favorable clinical outcome. CMPA is a prevalent clinical presentation of food allergy in infants and preschool children and nutritional consequences are also important in these age groups. Therefore, CMPA diagnosis should always be considered in patients with PEM, provided the primary malnutrition secondary to insufficient food intake is excluded. Keywords: Food allergy, protein–energy malnutrition, cows’ milk protein allergy.