Allergy to Cow’s Milk Protein Simulating Hirschsprung’s Disease Based on Barium Enema Findings. A Case Report

Abstract

Introduction. Cow's milk protein allergy can have multiple clinical manifestations. Some cases present with inflammation of the rectosigmoid colon with secondary colonic dysmotility similar to Hirschsprung's disease. Previous studies have shown that the proportion of cow's milk protein allergy in newborns presenting with Hirschsprung's disease-like symptoms is high. 

Aim. To describe the clinical case of a patient with cow's milk protein allergy, with symptoms and barium enema imaging suggestive of Hirschsprung's disease. 

Clinical case. A term infant, previously healthy, with episodes of regurgitation since two weeks of life and worsening of symptoms with vomiting and irritability at three months of age. Physical examination revealed findings compatible with cow's milk protein allergy. She was exclusively breastfed and instructed to continue on a cow's milk exclusion diet. Three days after the onset of symptoms, her condition worsened with vomiting and the imaging studies were expanded with findings that could have been related to Hirschsprung's Disease. An endorectal biopsy was performed and Hirschsprung's disease was ruled out. It was indicated to discontinue breastfeeding and continue with the amino acid-based formula, with adequate tolerance, weight and height progression, resolution of xeroderma and abdominal distension. 

Conclusion. In patients with severe abdominal distension or findings simulating Hirschsprung's disease, cow's milk protein allergy should be considered as an increasingly common entity in the differential diagnosis, and appropriate diagnostic tests should be performed to establish the diagnosis. Endorectal biopsy is indicated to confirm the definitive diagnosis of Hirschsprung's disease.