Understanding drug-induced enterocolitis | Pediatric Oncall Journal

CASE REPORTS

Understanding Drug-Induced Enterocolitis

Catarina Maria Queirós Fraga, Ana Rita Barroca Macedo, Ana Carolina Coelho de Castro, Georgeta Maria Costa Alves de Oliveira.

Pediatrics Department of Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Oporto, Portugal.

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Abstract
Drug-induced enterocolitis syndrome (DIES) is a rare but potentially fatal non-IgE-mediated hypersensitivity reaction triggered by drugs. It often presents with gastrointestinal symptoms similar to those of food protein-induced enterocolitis syndrome (FPIES). The authors report the case of a 10-year-old girl who suffered from severe vomiting and diarrhoea after taking amoxicillin-clavulanic acid. A hospital-based oral drug challenge with amoxicillin replicated her symptoms, confirming DIES diagnosis. Supportive measures led to positive outcomes. We discuss the diagnostic criteria, management strategies and the importance of greater awareness in identifying cases of DIES. Despite its rarity, we advocate for hospital-based oral challenges when DIES is suspected, facilitating prompt diagnosis and management of potentially severe reactions.

Why this article important?

This manuscript is significant as it portrays drug-induced enterocolitis syndrome (DIES), a rare yet potentially severe condition that can lead to life-threatening outcomes. Prompt identification and management are vital to mitigate its adverse endpoint. Diagnosing DIES can be challenging due to its similarity to other gastrointestinal disorders and the absence of specific tests. The authors discuss the diagnosis and the management of DIES, emphasizing the relevant role of oral drug challenge and supportive care in achieving full patient recovery. Moreover, they underscore the importance of conducting oral challenges within a hospital environment, thus elucidating the importance of such clinical procedures.

Summary of article

The authors present a case involving a 10-year-old girl with no prior medical history, with a suspected amoxicillin-clavulanic acid allergy. She was experiencing several episodes of severe vomiting and diarrhoea after the medication intake since the age of two. A subsequent hospital-based oral drug challenge with amoxicillin definitively confirmed the diagnosis of drug-induced enterocolitis syndrome (DIES). The implementation of supportive treatment measures culminated in the patient's complete recovery. Through discussion, diagnostic criteria and management strategies for DIES are examined, with particular emphasis placed on the significance of clinical awareness and the imperative nature of timely diagnoses facilitated by hospital-based oral challenges.

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