Recurrent Vomiting Research Articles

Meckel Diverticulitis with Acute Intestinal Obstruction in a 2-Month-Old Infant: a Case Report

Among the complications of Meckel diverticulum, the most commonly diagnosed are acute intestinal obstruction and diverticulitis. In infants, these pathological conditions are rare, and their combination has been reported only in isolated cases. Therefore, the present clinical observation is of interest to pediatric surgeons. A 2-month-old girl was transferred from a district hospital to the surgical department of a general hospital 20 hours after disease onset, presenting with signs of an acute abdomen, including recurrent vomiting, intermittent restlessness, abdominal distention, absence of stool, and fever. Ultrasound and radiography revealed multiple fluid levels and peritoneal effusion, indicating signs of intestinal obstruction. Following preoperative preparation, a laparotomy was performed through a right transrectal incision. In the abdominal cavity, turbid effusion and a distended, hyperemic, and edematous ileal loop were identified, compressed by a fibrous band extending from the root of the mesentery to the Meckel diverticulum. The diverticulum had a wide base and was located 30 cm from the ileocecal angle, phlegmonously altered. The fibrous band was excised, restoring intestinal patency. The strangulated intestinal loop was found to be viable. A wedge resection of the diverticulum was performed, followed by abdominal cavity sanitation. Diagnosis: Strangulated obstruction of the ileum, phlegmonous diverticulitis. The postoperative course was uneventful. The infant was discharged from the hospital in satisfactory condition. This clinical case illustrates the possibility of acute pathological conditions uncommon in infants and highlights the importance of early hospitalization in specialized pediatric surgical units when an acute abdominal syndrome is suspected.

A predictive tool for postoperative ileus after ileostomy closure: Model development and validation.

Postoperative ileus (POI) is a significant complication after ileostomy closure, which results in recurrent vomiting, dehydration, delay in starting enteral feeding, and even anastomotic breakdown. We aimed to develop a prediction model for POI occurrence after ileostomy closure. One hundred consecutive patients undergoing ileostomy closure were studied prospectively and data of various demographic and clinical variables were recorded in a predesigned proforma. The final prediction model was developed using logistic regression and internally validated in the next 50 patients. Factors associated with POI were age, body mass index, tobacco or alcohol addiction, comorbidity, anemia, thrombocytopenia, renal dysfunction, as shown by creatinine level, hypoproteinemia, hypernatremia, and hypokalemia. The mean score of those who developed POI was higher (p=0.002) than those who did not. A cut-off at score 8 had a sensitivity of 85.71%, specificity of 73.12%, and area under the curve was 0.8241 (SE 0.1123). The predictive model was validated in the next 50 consecutive patients and showed good sensitivity (80%) and specificity (93.3%). Our predictive model can determine the occurrence of POI with accuracy.

Carbon Dioxide and Hemoglobin at Presentation with Hypertrophic Pyloric Stenosis—Are They Relevant? Cohort Study and Current Opinions

Background: Recurrent vomiting in infantile hypertrophic pyloric stenosis (IHPS) leads to metabolic alkalosis and a respiratory-driven compensatory hypercapnia. Alkalosis has been identified as the main causal factor for respiratory depression on admission. The value of contribution of hemoglobin and carbon dioxide partial pressure to this phenomenon will be evaluated. Materials and Methods: A retrospective cohort study was conducted on 105 infants with IHPS. The acid/base status, including levels of hemoglobin and lactate, were recorded. Statistical comparisons, correlation analysis, linear regression and multivariate regression analysis were applied. Results: Hypercapnia was associated with hemoconcentration. We found a positive correlation was found between pCO2 and hemoglobin (p = 0.042). The multivariate linear regression analysis showed that pCO2 is dependent on hemoglobin (p = 0.002). Lactate, which is used as a marker for anaerobic glycolysis, showed no systematic correlation with pCO2. Conclusions: An increase in carbon dioxide cannot easily be attributed to a reduced transport function of carbon dioxide due to hemoglobin deficiency. Further investigation is needed to determine the extent to which low hemoglobin levels and increased pCO2 interact with hemoconcentration to contribute to respiratory problems.

Acute typical food protein-induced enterocolitis syndrome triggered by egg white

Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobulin E (IgE)-mediated food allergy characterized by gastrointestinal symptoms such as vomiting and diarrhea. Since 2018, hen’s egg yolk has been the most common trigger for FPIES in Japan, whereas typical egg white (TEW) FPIES remains rare. Herein, we present two cases of acute TEW FPIES in young children. A 17-month-old girl experienced recurrent vomiting and lethargy following egg white ingestion, despite previously tolerating half an egg yolk and 5 g of egg white. Initial tests showed no sensitization markers (egg white-specific IgE < 0.1 kUA/L; ovomucoid [OVM]-specific IgE < 0.1 kUA/L; skin prick test [SPT] negative). Three oral food challenges (OFCs) at 6-month intervals at our hospital all triggered vomiting and lethargy. Procalcitonin and thymus- and activation-regulated chemokine levels remained elevated for 24 hours, and even after 31 months, the patient had not achieved egg white tolerance. A 14-month-old girl presented with vomiting and lethargy after egg white ingestion while on a strict egg yolk- and egg white-free diet. Blood tests again showed no sensitization markers (egg white-specific IgE < 0.1 kUA/L; OVM-specific IgE < 0.1 kUA/L; SPT negative). Two OFCs at 6-month intervals confirmed FPIES, and even after 2 years, the patient had not achieved egg white tolerance. These cases highlight that egg white can trigger FPIES. Thorough medical history taking and diagnostic evaluation, including OFCs, are essential to distinguish FPIES from immediate-type food allergies.

Left Sided Diaphragmatic Eventration: A Rare Cause of Recurrent Vomiting.

Left Sided Diaphragmatic Eventration: A Rare Cause of Recurrent Vomiting.

Point-of-Care Ultrasound for Inpatient Management in a Korean Medicine Hospital: Case Series

Objectives: This study aimed to report the diagnostic role of point-of-care ultrasound (POCUS) in evaluating diverse clinical symptoms in inpatients admitted to a Korean medicine hospital.Methods: A retrospective case series was conducted on inpatients who underwent POCUS for symptom assessment during hospitalization at a Korean medicine hospital from 2023 to 2024. POCUS was performed by a Korean medicine doctor with over ten years of clinical and ultrasound experience. Ultrasound examinations were symptom-driven and carried out at the bedside.Results: Four representative cases are presented. In a pancreatic cancer patient with recurrent vomiting, upper abdominal ultrasound revealed gastric food retention. In a gastric cancer patient with peritoneal metastasis, ascites was visualized around the liver and bowel. Bladder ultrasound in a lymphoma patient with dysuria demonstrated significant residual urine. Soft tissue ultrasound in another lymphoma patient confirmed cellulitis following an inguinal lymph node biopsy. In all cases, POCUS enabled prompt symptom evaluation and guided clinical decision-making, with findings consistent with subsequent imaging or clinical outcomes.Conclusions: POCUS is a valuable diagnostic tool for bedside assessment in Korean medicine inpatients. It complements traditional diagnostic methods and enhances clinical responsiveness through real-time visualization of pathological findings.

Cannabinoid Hyperemesis Syndrome Is Associated With High Disease Burden: An Internet-Based Survey.

Cannabinoid Hyperemesis Syndrome Is Associated With High Disease Burden: An Internet-Based Survey.

Pancreatic Rest Complicated by Actinomyces Gastric Abscess in a Young Male: A Case Report

Pancreatic rest, or ectopic pancreatic tissue, is a rare condition. It is characterized by pancreatic tissue outside its usual location, most commonly in the gastric antrum or proximal small intestine. We present a rare case of a 21-year-old male with recurrent epigastric pain, vomiting, and fever. Imaging and endoscopic ultrasound (EUS) identified a subepithelial lesion with features consistent with pancreatic rest. Subsequent fine-needle aspiration (FNA) grew Actinomyces and Streptococcus. Given persistent symptoms and incomplete resolution despite prolonged antibiotics, he underwent partial gastrectomy. This case highlights an unusual infectious complication of pancreatic rest with Actinomyces and underscores the need to consider surgical intervention in cases refractory to medical therapy.

WHEN WATER BECOMES A FRENEMY

INTRODUCTIONPolydipsia is defined as excessive thirst causing the consumption of large amounts of fluids, more than 2 liters/m²/day in children, with consequential polyuria. It is of paramount importance to distinguish between diabetes insipidus (DI) and primary polydipsia as treatment differs, and inappropriate use of desmopressin can be detrimental in patients with primary polydipsia. CASEWe present 3 children referred to the Paediatric Endocrine Clinic who exhibited a long history of excessive drinking. Case 1. A 9-year-old male presented with an unquenchable thirst, drinking 6 to 8 L per day that required him to wake up 3–4 times nightly to drink water. A water deprivation test was performed, yielding inconclusive results, hence needed further investigation. Case 2. A 9-year-old male's excessive drinking during school hours concerned his teachers, prompting an investigation. A subsequent water deprivation test confirmed primary polydipsia. Case 3. A 2-year-old toddler presented with a progressive history of excessive drinking. Although his water deprivation test showed equivocal findings, his cranial MRI confirmed the diagnosis of central DI. Fortunately, our patients did not demonstrate any red flags, such as dehydration, visual field loss, recurrent vomiting, headache or altered consciousness. Our school-going patients denied a history of school bullying or truancy. None of the children were on medication and there was no family history of similar symptoms. CONCLUSIONThese cases underscore the importance and limitations of a water deprivation test in diagnosing polydipsia and polyuria in children. Inconclusive results must be interpreted with caution and necessitate further investigation, as baseline clinical and biochemical variables cannot substitute for the water deprivation test.

Metachronous Malignancy (Pancreatic Endocrine Neoplasm And Renal Cell Carcinoma): Case Report.

Index patient is a 61 year old African American male, with a past medical history (PMHx) of morbid obesity (BMI = 73), osteoarthritis (bilateral knees), venous stasis dermatitis, Obstructive sleep apnea (OSA) on CPAP, HTN, and NIDDM .Patient underwent right nephrectomy following an incidental finding of right renal mass on evaluation in the Emergency Room (ER) for chest pain and shortness of breath (SOB). A CT chest with contrast done to evaluate for pulmonary embolism in the ER revealed a 5.3cm right thyroid lobe mass; an indeterminate partially imaged right renal mass and an indeterminate hyper enhancing mass adjacent to the pancreatic neck. Subsequently; a CT abdomen and pelvis with contrast demonstrated a 2.6 x 2.5 cm pancreatic soft tissue attenuation (figure 2) with centrally increased attenuation and a solid heterogeneous exophytic mass of the anterior upper right kidney, measuring 5.4 x 4.8 cm with multiple lobulations. On discharge, patient underwent a CT guided biopsy of the pancreatic body with pathology significant for well- differentiated PEN. He was then scheduled for a right nephrectomy and pancreatectomy. Unfortunately, surgery was aborted after the right nephrectomy was undertaken, secondary to patient’s body habitus. Pathology specimen showed right kidney renal cell carcinoma (RCC) measuring 6.8 x 4.5 x 2.4 cm (of the clear cell type) and limited to the kidney with no invasion of the renal capsule (Figure 2). All surgical resection margins were negative for carcinoma. Patient was discharged on post-operative day 6. He then underwent genetic evaluation for possible Von Hippel-Lindau (VHL) disease; results were negative. Following a post-nephrectomy CT Abdomen/Chest with contrast which showed hyper vascular metastatic liver lesions; 6months later, patient underwent a biopsy of the liver that revealed metastatic well differentiated neuroendocrine tumor. He subsequently underwent hormonal therapy with lanreotide monthly infusions ( x 12 infusions). A repeat CT Abdomen/pelvis showed an unchanged 2.6cm lesion within the neck/body of the pancreas, and multiple vague arterially enhancing liver lesions, compatible with known metastatic liver-pancreatic endocrine neoplasm. There was no metastasis to the chest or pelvis. He was seen by the Otolaryngology service, following complaints of difficulty in swallowing, and subsequently underwent right sided thyroidectomy. Pathology report showed Multinodular goiter. He is currently stable, and has seen a decrease in weight from 555lbs to 469lbs. Patient was subsequently seen in the hospital for worsening renal function, associated with recurrent abdominal pain, nausea, vomiting, and diarrhea. He was noted to be positive for Clostridium Difficile colitis and placed on oral Vancomycin. He had a repeat computed tomography (CT) Abdomen/pelvis which demonstrated a poorly evaluated mass of the right hepatic lobe measuring 3.6 x 2.3 cm. He was discharged to a nursing home and died at the facility secondary to a fall at the facility.

Unusual Presentation of Seizure in a Child: A Case of Abdominal Epilepsy and Associated Diagnostic Dilemmas

Abdominal Epilepsy (AE) is a rare and often under-recognised form of epilepsy that typically presents in children with gastrointestinal symptoms, such as recurrent vomiting. This condition can easily be misdiagnosed due to its atypical presentation, leading to delayed treatment and prolonged distress for patients and their families. Despite its rarity, AE should be considered in children with unexplained recurrent vomiting, particularly when other diagnoses fail to explain the symptoms. This is a unique case report of a 14-year-old boy who presented with a history of headache, persistent vomiting and dehydration that did not resolve with initial conservative treatment. Given the persistent nature of his symptoms, an Electroencephalogram (EEG) was performed, which confirmed the diagnosis of AE. The EEG revealed characteristic epileptic discharges that were not initially recognised as related to gastrointestinal symptoms. Following the diagnosis, the patient was started on sodium valproate, which led to a significant improvement in his symptoms. This case highlights the importance of considering AE in children with recurrent vomiting, especially when initial treatments do not yield results. It underscores the need for careful diagnostic work-up, including EEG and appropriate treatment with anticonvulsants.

Homozygous STAT-1 Loss of Function Presenting with Recurrent Respiratory Infections and Pneumocystis jirovecii Pneumonia

Background Autosomal recessive complete STAT-1 deficiency is a rare primary immunodeficiency characterized by predisposition to life-threatening viral and mycobacterial infections due to loss of STAT-1–dependent responses to type I/II interferons. We present a case of complete STAT-1 deficiency presenting with severe respiratory infections. Case A 5-week-old, ex–full-term female infant was admitted for RSV bronchiolitis with superimposed MRSA pneumonia and bacteremia requiring intubation. At 2 months, she required noninvasive ventilatory support for rhinovirus infection and treatment for aspiration pneumonia. At 4 months, she was treated for COVID-19 pneumonia. Her history prompted workup for immunodeficiency; she had normal T and B cells, immunoglobulins, and adequate titers to killed vaccines. Genetic testing revealed homozygous deletion in STAT1 (exons 7-9). Functional studies demonstrated absence of STAT-1 phosphorylation to interferon-gamma, supportive of complete STAT-1 deficiency. She was started on prophylactic IVIG and acyclovir and regularly screened for EBV, CMV, and HHV-6. At 5 months, she presented with fever, respiratory distress, and recurrent emesis with leukocytosis and elevated inflammatory markers without a clear source. Ultimately, Pneumocystis jirovecii pneumonia was diagnosed by PCR from bronchoalveolar lavage; she improved with trimethoprim-sulfamethoxazole. During infectious workup, Karius testing returned positive for Mycobacterium abscessus. Given high risk for mycobacterial infection, empiric treatment with azithromycin, amikacin, and linezolid was initiated. At 10 months, she underwent an alpha-beta T cell–depleted haploidentical peripheral blood SCT from her father. Planned conditioning regimen was rituximab, targeted dosing rATG, targeted busulfan, targeted fludarabine, and thiotepa. She had an anaphylactic reaction to Rituximab on Day -1; no further doses of rituximab were given. Graft-versus-host prophylaxis was tocilizumab and abatacept. Engraftment occurred on Day +13. Immediate post-transplant course was initially complicated by persistent host T cells, concerning for a high risk of immunological rejection, but she has since continued to have improvement of donor CD3 chimerism. She is currently Day +50 without signs of GVHD or viral reactivation and continues abatacept monthly. Discussion Complete STAT1 deficiency is a severe immunodeficiency that is historically fatal in early life without curative HSCT. Our case supports the need for early transplant before the acquisition of and complications due to severe infections.

A rare postoperative complication in the treatment of a child with congenital hydronephrosis: A case report

Congenital hydronephrosis is a common developmental anomaly typically diagnosed prenatally. Laparoscopic pyeloplasty is considered the gold standard for the treatment of ureteropelvic junction obstruction due to its high success rate (93–98%) and low incidence of complications. However, hemorrhagic complications remain a concern, particularly in cases of abrupt reductions in intrapelvic pressure, inadequate hemostasis, or coagulopathy, and may be exacerbated by antifibrinolytic therapy. This report describes a clinical case of a male patient with prenatally diagnosed right-sided hydronephrosis, who underwent initial radiologic evaluation at the age of 4. Surgical treatment was recommended but declined by his parents. At age 6, the child was urgently hospitalized with recurrent abdominal pain and vomiting. After stabilization and pain relief, ultrasonography, contrast-enhanced computed tomography, and voiding cystourethrography confirmed the diagnosis of right-sided hydronephrosis and recurrent renal colic. Laparoscopic antevascular pyeloplasty was performed. On postoperative day 2, hemorrhagic urine output was observed through the drain, accompanied by pyelostomy dysfunction. Tranexamic acid, an antifibrinolytic agent, was administered to manage hematuria, resulting in tamponade of the renal pelvis due to blood clot formation. A repeat laparoscopic procedure was required for clot evacuation and placement of additional drains. Subsequent recovery was favorable, with restoration of renal function and urinary drainage, and an uneventful postoperative course. This case underscores the importance of meticulous intraoperative hemostasis and adequate fluid therapy to prevent postoperative complications. The use of antifibrinolytics for gross hematuria following pyeloplasty requires an individualized approach due to the risk of intraluminal thrombosis, renal pelvis tamponade, and potential loss of renal function. In such cases, timely surgical intervention may help preserve renal function.

Expanding the Clinical and Genetic Spectrum of Mitochondrial Short-Chain Enoyl-CoA Hydratase 1 Deficiency: Insights From Two Unrelated Chinese Families.

Mitochondrial short-chain enoyl-CoA hydratase 1 deficiency (ECHS1D) is a rare autosomal recessive disorder affecting valine metabolism, with clinical severity ranging from neonatal death to survival into adulthood. Despite advances in understanding ECHS1D, the genetic basis remains underexplored, particularly in underrepresented populations. This study aimed to investigate the clinical and genetic characteristics of ECHS1D in two unrelated Chinese families and identify novel pathogenic variants. Clinical and genetic data were collected, and whole-genome sequencing was performed to identify pathogenic variants in the ECHS1 gene. The first proband, a 15-month-old girl, presented with developmental delays and metabolic acidosis, with an MRI revealing abnormal signals in the basal ganglia. The second proband, a 6.5-year-old girl with movement-induced dystonia, exhibited lethargy following recurrent fever and vomiting, with similar MRI findings. Genetic testing identified novel compound heterozygous variants: c.759_762del (p.Gly255Valfs*21) and c.489G>A (p.Pro163=) in Proband 1 and c.518C>T (p.Ala173Val) and c.244G>A (p.Val82Met) in Proband 2. The c.759_762del (p.Gly255Valfs21) variant, identified for the first time, likely results in severe symptoms due to a loss of normal function. These findings expand the ECHS1 mutational spectrum and emphasize the importance of genetic testing for early diagnosis and personalized management of ECHS1D. Interventions such as dietary valine restriction and the avoidance of triggering factors may improve clinical outcomes, while further research is needed to explore targeted therapeutic strategies.

Report and literature review of a familial case of autoinflammatory disease associated with RELA gene variant

To explore the clinical phenotype and genetic characteristics of a pediatric child with RELA-associated autoinflammatory disease (RAID) caused by a RELA gene variant, and to review the reported cases in the literature. A pediatric child with RAID who presented with recurrent fever, vomiting, and oral ulcers for over 5 years was selected as the study subject. The child visited the Women and Children's Hospital of Ningbo University in August 2023. Clinical data were collected, and peripheral blood samples were obtained from the child and his family members for whole-exome sequencing (WES) and Sanger sequencing to identify and validate candidate variants. The pathogenicity of the variants was analyzed accordingly. Using the keywords "RELA" "NF-κB" "autoinflammatory disease" "tofacitinib" "sulfasalazine" a literature search was conducted in the China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and PubMed from January 1, 2000 to December 13, 2023. This study was approved by the Medical Ethics Committee of the Women and Children's Hospital of Ningbo University (Ethics No. EC2020-048). The child primarily manifested with recurrent fever, vomiting, and oral ulcers. WES identified a heterozygous nonsense variant c.985C>T (p.Arg329Ter) in the RELA gene, which was inherited from the mother. According to the American College of Medical Genetics and Genomics (ACMG) Standards and Guidelines for the Interpretation of Sequence Variants and the Clinical Genome Resource (ClinGen) recommendations for PVS1, this variant was classified as pathogenic (PVS1+PM2_Supporting+PP4). Despite treatment with adalimumab and tocilizumab, the child's symptoms persisted. Switching to tofacitinib improved oral ulcers, but fever and vomiting continued. The addition of thalidomide significantly alleviated fever and vomiting, and the patient's growth and development remained normal. A literature review identified 14 unrelated RAID families, including a total of 35 cases (including the present child). The main clinical features were recurrent oral ulcers, genital ulcers, skin problems, fever, diarrhea, abdominal pain, and vomiting. The nonsense variant c.985C>T (p.Arg329Ter) in the RELA gene is likely the genetic cause of the child's recurrent fever, vomiting, and oral ulcers. WES is valuable for timely diagnosis of RAID and provides a basis for clinical treatment strategies.

Differentiating Diabetic Gastroparesis and Cannabis Hyperemesis Syndrome in People With Type 1 Diabetes

Cannabinoid hyperemesis syndrome (CHS) is recurrent nausea, vomiting, and abdominal pain due to prolonged cannabis use. This study aimed to differentiate the significant overlap in presentations of diabetic gastroparesis (DG) and CHS in people with type 1 diabetes. It found that older age, longer diabetes duration, female sex, lower A1C, and presence of diabetic neuropathy are indicators favoring a diagnosis of DG over CHS in people with type 1 diabetes.

Pediatric abdominal migraine as a recurrent emergency department presentation: a case report

Pediatric functional abdominal disorders are some of the most commonly encountered disorders in childhood, and a recurrent presentation in the emergency department. Distinguishing functional disorders from organic causes is crucial to safe patient care and to identify optimal treatment strategies. We present a case of a 9-year-old boy with recurrent presentations of diffuse abdominal pain associated with nausea, recurrent vomiting and headache. He had no red flag symptoms, and his mother had a history of migraine headaches. Emergency department investigations demonstrated normal bloodwork, with ultrasound demonstrating only trace small volume deep pelvic ascites of unknown etiology. He was subsequently diagnosed with pediatric abdominal migraine, and counselled on the cornerstones of nonpharmacologic management. This case highlights the importance of assessing for red flags of abdominal pain and using strict diagnostic criteria when considering functional abdominal disorders in childhood.

Una carenza di vitamina B12... contagiosa

The paper reports the case of a seven-month-old infant presenting with recurrent vomiting, severe pallor, hypotonia and growth arrest. Laboratory tests revealed pancytopenia with macrocytic anaemia, hyperhomocysteinemia and markedly elevated methylmalonic acid levels, indicating vitamin B12 deficiency. The mother, despite an omnivorous diet, was also found to have vitamin B12 deficiency due to autoimmune atrophic gastritis. After one week of hydroxocobalamin therapy, the infant’s clinical and laboratory findings improved significantly. This case highlights the importance of early recognition of vitamin B12 deficiency to prevent severe neurological consequences.

Adenocarcinoma mucinoso gástrico associado a helicobacteriose e paracoccidioidomicose em cadela

Gastric tumors in dogs are an uncommon pathology within neoplasms, and can present themselves by several factors such as the presence of antigens, in this context, this material addresses morphological and histopathological aspects of a case of gastric mucinous adenocarcinoma associated with helicobacteriosis and paracoccidioidomycosis in a 12-year-old chow-chow dog who had recurrent emesis with decreased appetite, and that she underwent partial gastrectomy. Ultrasound examination showed hyperechoic lesions in the gastric mucosa and sharply thickened walls, so endoscopy was requested, which demonstrated the existence of multiple ulcerative lesions and mucosa containing metaplasias, necrotic points and hemorrhagic foci. Next, a biopsy of the gastric mucosa was performed, in which 16 fragments were sent for histopathological analysis, and neoplastic proliferation of epithelial origin with malignant biological behavior was found. It was also possible through this analysis to diagnose the patient with mucinous adenocarcinoma, which is classified as invasive due to its disposition and tissue organization in the stomach; Chronic inflammatory reactions were also found associated with structures compatible with helicobacteriosis and paracoccidioidomycosis, possibly also related to dysplasia. This case report aims to correlate the tumor diagnosis with fungal and bacterial infection, seeking to associate the emergence and progression of the pathology with the aforementioned antigens (Helicobacter spp. and Paracoccidioides spp.), based on other literature that discusses similar cases and/or the profile of the antigens described.

Treatments for gastrointestinal symptoms in acute food protein-induced enterocolitis syndrome

The treatment for acute food protein-induced enterocolitis syndrome (FPIES) has not been fully resolved. We investigated the efficacy of 5-HT3 receptor inhibitors and steroids in patients with recurrent vomiting during the oral food challenge test (OFC) for acute FPIES. Patients who met the diagnostic criteria of the international guidelines of acute FPIES and developed recurrent vomiting with the OFC were enrolled. Patients who had a single vomiting underwent infusion with normal saline. A 5-HT3 receptor inhibitor was administered intravenously when recurrent vomiting appeared with lethargy and/or pallor. If the patient continued to develop persistent symptoms, additional steroids were administered intravenously. This study examined the rate of OFCs in which the administration of a single 5HT3 inhibitor was insufficient to improve gastrointestinal symptoms, requiring the additional administration of steroids. A total of 20 OFCs were included; 2 treated with infusion therapy, 9 OFCs treated with 5-HT3 receptor inhibitor, and 9 OFCs treated with 5-HT3 receptor inhibitors and steroids. Nine OFCs treated with a single 5-HT3 receptor inhibitor were effective, with only 2 episodes of vomiting observed before administration, and none after treatment. In the remaining 9 OFCs, steroids were additionally administered due to persistent symptoms. Five of 7 OFCs with persistent vomiting improved, and all 7 OFCs with persistent lethargy improved. This study revealed that in OFCs performed due to acute FPIES leading to recurrent vomiting, monotherapy with 5-HT3 receptor inhibitors was insufficient in half of the OFCs, suggesting that combination therapy with 5-HT3 receptor inhibitors and steroids should be considered for severe OFCs.