Case Report - Puffy eyes and pale face in a 2 year girl due
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A 2-year-old girl, fed with a goat milk-based formula, presented with progressively puffy eyes over two weeks. No fever, cardiovascular symptoms, or gastrointestinal symptoms were mentioned. The girl was born at a gestational age of 28 weeks, with a birth weight of 890 grams and a birth length of 32 cm.

On examination, her weight was 10.5 kg, and height was 81.4 cm. Periorbital pitting edema and facial pallor were noted. There was no obvious pitting edema in the upper and lower extremities. Laboratory studies revealed a microcytic anemia (4.4 g/dL of hemoglobin with mean corpuscular volume of 44 fL), hypoproteinemia (1.9 g/dL of albumin, 3.0 g/dL of total protein), and iron deficiency (<1 ng/mL of ferritin). Other laboratory findings, including those of heart, liver, and kidney function, were normal. Urine analysis showed no proteinuria. Stool examination indicated a positive occult blood test result and elevated alpha-1 antitrypsin level (27.4 mg/g).

An endoscopy was performed with biopsy which presented erythematous change and multiple nodules. Histology demonstrated increased eosinophils in the lamina propria and the epithelium. Eosinophilic gastroenteritis with protein-losing enteropathy and iron deficiency anemia were diagnosed.

Eliminaton of the goat milk-based formula was done from the patient's diet and changed to an amino acid-based formula. She also received oral iron replacement treatment. Within one month, her swollen eyes resolved and her anemia and hypoproteinemia improved.

Source: https://www.jpeds.com/article/S0022-3476(20)31058-1/fulltext
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