2011 Volume 25 Issue 1 Pages 98-103
A case of intestinal cow's milk allergy (ICMA) in early infancy complicated by methemoglobinemia was reported. An one-month-old bottle-fed male infant was referred to our institute because of high fever, diarrhea, vomiting and growth failure. He showed cyanosis refractory to the administration of oxygen. Laboratory examinations revealed not only a rise in the CRP level, but also a marked increase in the methemoglobin level (up to 32.4%). All these symptoms and abnormal laboratory findings including methemoglobinemia were solved by discontinuation of feeding without any other specific therapy.
Although soy milk caused the same symptoms, he was fed uneventfully with amino acid formula. Allergen-specific lymphocyte stimulation test for cow's milk protein (kappa-casein) was shown to be positive. A challenge of cow's milk formula performed at 2 months of age caused high fever, diarrhea, vomiting and cyanosis. Methemoglobinemia and an increase in the CRP level were also confirmed by laboratory examinations. These findings suggest that the cell-mediated immunity against cow's milk proteins plays a significant role in the development of methemoglobinemia as well as other symptoms. Although methemoglobinemia is an uncommon complication of ICMA, physician should pay enough attention because it is a possible life threatening disorder.
