Eosinophilic gastrointestinal disorder in an infant with feeding dysfunction.

Feeding dysfunction (FD) has recently been considered to comprise a prevalent set of symptoms in eosinophilic gastrointestinal disorders (EGIDs) in young children. We report the case of an 8-month-old girl with an EGID who visited our hospital due to vomiting, poor weight gain and feeding difficulties; her condition was discovered during the examination of the symptoms including FD. Tracheal aspiration and reduced esophageal clearance showed up in a barium swallow test and upper gastrointestinal contrast radiography, respectively. Delayed clearance from the stomach was also detected on gastrointestinal scintigraphy. Gastrointestinal endoscopy and biopsies revealed esophagitis with some eosinophils and duodenitis with eosinophilic inflammation. She was not a likely candidate for eosinophilic esophagitis. On administration of an elemental diet, the patient gained weight. Esophageal and stomach clearance subsequently improved, although the vomiting and FD persisted to some extent. We conclude that it is important to consider other EGIDs as well as eosinophilic esophagitis in the differential diagnosis of FD.

Interstitial pregnancy in a woman with congenital afibrinogenemia.

Without fibrinogen replacement, pregnancies in patients with congenital afibrinogenemia end in miscarriage between 6 and 8 weeks of gestation. Studies in animal models suggest that disturbance of the embryo's decidual attachment contributes to miscarriage in afibrinogenemia. Ectopic pregnancy in human congenital afibrinogenemia has not been previously documented. We present a case of right interstitial pregnancy in a woman with congenital afibrinogenemia, who had not received the recommended fibrinogen replacement for the first 6 weeks of pregnancy. The pregnancy followed a right salpingo-oophorectomy for ovarian hemorrhage. Therefore the embryo most likely entered the uterine cavity via the left tube only to move upstream into the lumen of the interstitial portion of the right tube. Our experience suggests that disturbance of the embryo's decidual attachment may have contributed to the development of an ectopic pregnancy. Therefore, fibrinogen replacement early in the first trimester is of utmost importance.