Autoimmune enteropathy is a rare cause of infantile diarrhea. Cases typically involve infants with a protracted course of diarrhea found to have underlying autoimmune disease or immune dysfunction, leading to chronic intestinal inflammation. We describe a case of immune-mediated enteropathy in an infant with no identifiable autoimmune disease. The patient was exclusively breastfed by his mother who had Crohn's disease, and he was found to have circulating anti-enterocyte immunoglobulin A (IgA) antibody. There was no circulating anti-enterocyte immunoglobulin G or immunoglobulin M. The patient's disease and symptoms resolved with cessation of breastfeeding, and no immunomodulatory medications have been needed in 20 months of follow-up. The case raises suspicion for alloimmune disease, and it is hypothesized that intestinal injury was mediated by maternally transmitted anti-enterocyte IgA antibody.
1Seattle Children's Hospital, Seattle, WA
2University of Washington School of Medicine, Seattle, WA
3Department of Laboratories, Seattle Children's Hospital, Seattle, WA
4Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, WA
5Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Seattle, WA
6Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
Correspondence: Matthew J. Giefer, MD, Division of Gastroenterology and Hepatology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105 (Matthew.Giefer@seattlechildrens.org).
Received June 14, 2018
Accepted March 26, 2019
Online date: June 14, 2019
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