Successful Montelukast Treatment in an Infant with Steroid-Resistant Eosinophilic Colitis
Eosinophilic colitis (EC) belongs to a group of idiopathic diseases called eosinophilic gastrointestinal disorders, which are characterized by eosinophil-predominant inflammation in the gastrointestinal tract. Corticosteroids is the first-line pharmacotherapy for EC refractory to diet therapy. We re...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2021-03-01
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| Series: | Case Reports in Gastroenterology |
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| Online Access: | https://www.karger.com/Article/FullText/513146 |
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| author | Nai-Wei Wang Hsuan Hsieh Yao-Jong Yang |
| author_facet | Nai-Wei Wang Hsuan Hsieh Yao-Jong Yang |
| author_sort | Nai-Wei Wang |
| collection | DOAJ |
| description | Eosinophilic colitis (EC) belongs to a group of idiopathic diseases called eosinophilic gastrointestinal disorders, which are characterized by eosinophil-predominant inflammation in the gastrointestinal tract. Corticosteroids is the first-line pharmacotherapy for EC refractory to diet therapy. We report an infant with steroid-resistant EC, who successfully returned to a healthy growth trajectory under the combined therapy of montelukast and ketotifen. An 8-month-old boy presented with bloody diarrhea, anemia, and failure to thrive (FTT) that started 6 days after birth. The patient has no known allergies. A trial of elementary diet was unsuccessful. The results of several stool cultures were unremarkable. Similarly, lower gastrointestinal series failed to identify anything significant. At 3 months of age, an esophagogastroduodenoscopy with biopsies from the distal duodenum and proximal jejunum were unremarkable. The diarrhea and FTT persisted. A rectosigmoidoscopy with biopsies was performed; the results led to the diagnosis of EC at 5 months of age. Oral prednisolone 1 mg/kg/day was prescribed; however, 3 months into the treatment, persistent bloody diarrhea and FTT were still noted. Montelukast and ketotifen were added, after which diarrhea and weight gain started to improve. Prednisolone and montelukast/ketotifen were tapered off 6 months after. He remains symptom free and has normal growth and development in a 5-year follow-up. |
| first_indexed | 2024-12-22T05:42:18Z |
| format | Article |
| id | doaj.art-d8933259a2e1430cacfa29656c9fb79d |
| institution | Directory Open Access Journal |
| issn | 1662-0631 |
| language | English |
| last_indexed | 2024-12-22T05:42:18Z |
| publishDate | 2021-03-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Gastroenterology |
| spelling | doaj.art-d8933259a2e1430cacfa29656c9fb79d2022-12-21T18:37:10ZengKarger PublishersCase Reports in Gastroenterology1662-06312021-03-0115138939410.1159/000513146513146Successful Montelukast Treatment in an Infant with Steroid-Resistant Eosinophilic ColitisNai-Wei Wang0Hsuan Hsieh1Yao-Jong Yang2Hull York Medical School, Allam Medical Building, University of Hull, Hull, United KingdomDepartment of Pediatrics, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, TaiwanDepartment of Pediatrics, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, TaiwanEosinophilic colitis (EC) belongs to a group of idiopathic diseases called eosinophilic gastrointestinal disorders, which are characterized by eosinophil-predominant inflammation in the gastrointestinal tract. Corticosteroids is the first-line pharmacotherapy for EC refractory to diet therapy. We report an infant with steroid-resistant EC, who successfully returned to a healthy growth trajectory under the combined therapy of montelukast and ketotifen. An 8-month-old boy presented with bloody diarrhea, anemia, and failure to thrive (FTT) that started 6 days after birth. The patient has no known allergies. A trial of elementary diet was unsuccessful. The results of several stool cultures were unremarkable. Similarly, lower gastrointestinal series failed to identify anything significant. At 3 months of age, an esophagogastroduodenoscopy with biopsies from the distal duodenum and proximal jejunum were unremarkable. The diarrhea and FTT persisted. A rectosigmoidoscopy with biopsies was performed; the results led to the diagnosis of EC at 5 months of age. Oral prednisolone 1 mg/kg/day was prescribed; however, 3 months into the treatment, persistent bloody diarrhea and FTT were still noted. Montelukast and ketotifen were added, after which diarrhea and weight gain started to improve. Prednisolone and montelukast/ketotifen were tapered off 6 months after. He remains symptom free and has normal growth and development in a 5-year follow-up.https://www.karger.com/Article/FullText/513146eosinophilic colitismontelukaststeroid-sparing therapydiarrhea |
| spellingShingle | Nai-Wei Wang Hsuan Hsieh Yao-Jong Yang Successful Montelukast Treatment in an Infant with Steroid-Resistant Eosinophilic Colitis Case Reports in Gastroenterology eosinophilic colitis montelukast steroid-sparing therapy diarrhea |
| title | Successful Montelukast Treatment in an Infant with Steroid-Resistant Eosinophilic Colitis |
| title_full | Successful Montelukast Treatment in an Infant with Steroid-Resistant Eosinophilic Colitis |
| title_fullStr | Successful Montelukast Treatment in an Infant with Steroid-Resistant Eosinophilic Colitis |
| title_full_unstemmed | Successful Montelukast Treatment in an Infant with Steroid-Resistant Eosinophilic Colitis |
| title_short | Successful Montelukast Treatment in an Infant with Steroid-Resistant Eosinophilic Colitis |
| title_sort | successful montelukast treatment in an infant with steroid resistant eosinophilic colitis |
| topic | eosinophilic colitis montelukast steroid-sparing therapy diarrhea |
| url | https://www.karger.com/Article/FullText/513146 |
| work_keys_str_mv | AT naiweiwang successfulmontelukasttreatmentinaninfantwithsteroidresistanteosinophiliccolitis AT hsuanhsieh successfulmontelukasttreatmentinaninfantwithsteroidresistanteosinophiliccolitis AT yaojongyang successfulmontelukasttreatmentinaninfantwithsteroidresistanteosinophiliccolitis |