Failure of Fecal Microbiota Transplantation in a Three-Year-Old Child with Severe Refractory Ulcerative Colitis.

Fecal microbiota transplantation (FMT) is a treatment designed to correct gut dysbiosis by administration of feces from a healthy volunteer. It is still unclear whether FMT for children with ulcerative colitis (UC) is effective or hazardous. Here we describe a young patient to have received FMT for UC. A three-year-old girl was admitted to our hospital with severe active UC, and treated with aminosalicylates and various immunosuppressive drugs. As remission was not achieved, we decided to try FMT before colectomy. We administered donor fecal material a total of six times by retention enema (×2) and via a nasoduodenal tube (×4) within 10 days. The patient developed abdominal pain and pyrexia after each FMT session. Analyses revealed the transferred donor fecal microbiota had not been retained by the patient, who ultimately underwent colectomy. The severity of the UC and/or timing of FMT may have partly accounted for the poor outcome.

A 4-year-old girl with chronic nonspecific multiple ulcers of the small intestine diagnosed by double-balloon endoscopy.

We present the youngest patient reported to date with chronic nonspecific multiple ulcers of the small intestine (CNSU) diagnosed by double-balloon endoscopy (DBE). A 3-year-old girl was referred to our department with a 2-year history of iron-deficiency anemia. Failure to thrive and hypoproteinemia were also noted, and stool occult blood tests had been persistently positive. However, the C-reactive protein level and erythrocyte sedimentation rate were not elevated. Esophagogastroduodenoscopy and double-contrast enema revealed no abnormality in the colon and terminal ileum. Retrograde DBE was performed when the patient was 4 years old. Linear ulcerations arranged in an oblique or circular pattern were present at 3 sites between 55 and 65 cm from the ileocecal valve. Microscopic examination showed nonspecific inflammatory changes, and no granuloma was present. Based on the clinical and endoscopic findings, the patient was diagnosed as having CNSU. The youngest previously reported patient with CNSU was 7 years old, whereas our present patient was diagnosed at the age of 4 years. In pediatric cases of obscure gastrointestinal bleeding, it may be necessary to be aware of small bowel disease.

Hypokalemic rhabdomyolysis in a child with Gitelman's syndrome.

We report here the first published case of a pediatric patient with Gitelman's syndrome (GS) in whom hypokalemia-associated rhabdomyolysis developed. A 13-year-old girl was admitted with weakness of the extremities, walking difficulty and calf pain. Laboratory data showed a serum potassium level of 2.1 mmol/l and a serum creatinine phosphokinase level of 1,248 IU/l plus myoglobinemia. The presence of normomagnesemia was the basis for a genetic analysis of the thiazide-sensitive sodium chloride cotransporter gene, which revealed compound heterozygous mutations in this gene. Prompt fluid expansion and potassium supplementation led to regression of the muscle symptoms. Hypokalemia can be a rare cause of rhabdomyolysis in patients with GS, even in childhood. We emphasize that genetic analysis is advisable to determine whether the suspicion of GS is warranted.