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Bruising as the first sign of exocrine pancreatic insufficiency in infancy.
Med Pharm Rep 2019; 92(2):200-204MP

Abstract

Exocrine pancreatic insufficiency is an important cause of chronic malnutrition, secondary to maldigestion-malabsorption, which can be caused in children especially by cystic fibrosis, but also by other much rarer diseases. The case of a 6 months and 3 weeks old male pediatric patient is reported, who was admitted to the clinic for head and forearms bruising. Laboratory findings identified vitamin K deficiency as the cause of the cutaneous hemorrhagic syndrome. Further investigations revealed association of steatorrhea (which is a marker of fat malabsorption), iron-deficiency anemia and hypovitaminosis D, which had been produced by nutritional deficiencies caused by malabsorption syndrome. From the numerous disorders that could be associated with pancreatic insufficiency in children, the following conditions had been excluded: cystic fibrosis (mucoviscidosis), cow's milk protein intolerance, gluten-sensitive enteropathy (coeliac disease), Shwachman-Diamond syndrome, abetalipoproteinemia, etc. Based upon decreased levels of stool pancreatic elastase in repeated measurements, together with low serum lipase, the final diagnosis of exocrine pancreatic insufficiency was established. Treatment of this case consisted mainly in pancreatic enzyme replacement therapy, but also oral iron supplementation and dietary supplements with fat-soluble vitamins (A, D, E, K). The outcome was favorable, characterized by normalization of intestinal passage, ascending growth curve and normalization of the majority of laboratory tests values that were modified between the time of patient admission to our clinic and initiation of specific therapy (serum level of vitamin K, vitamin D and lipase, coagulation profile, hemoglobin and red blood cell indexes), as well as higher value of fecal pancreatic elastase.

Authors+Show Affiliations

Department of Pediatrics I, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. Pediatric Clinic I, Pediatric Emergency Hospital, Cluj-Napoca, Romania.Pediatric Clinic I, Pediatric Emergency Hospital, Cluj-Napoca, Romania.Department of Pediatrics I, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. Pediatric Clinic I, Pediatric Emergency Hospital, Cluj-Napoca, Romania.Department of Pediatrics I, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. Pediatric Clinic I, Pediatric Emergency Hospital, Cluj-Napoca, Romania.Department of Pediatrics I, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. Pediatric Clinic I, Pediatric Emergency Hospital, Cluj-Napoca, Romania.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31086851

Citation

Szabo, Csilla Enikő, et al. "Bruising as the First Sign of Exocrine Pancreatic Insufficiency in Infancy." Medicine and Pharmacy Reports, vol. 92, no. 2, 2019, pp. 200-204.
Szabo CE, Man OI, Şerban RS, et al. Bruising as the first sign of exocrine pancreatic insufficiency in infancy. Med Pharm Rep. 2019;92(2):200-204.
Szabo, C. E., Man, O. I., Şerban, R. S., Kiss, E., & Lazăr, C. F. (2019). Bruising as the first sign of exocrine pancreatic insufficiency in infancy. Medicine and Pharmacy Reports, 92(2), pp. 200-204. doi:10.15386/mpr-1231.
Szabo CE, et al. Bruising as the First Sign of Exocrine Pancreatic Insufficiency in Infancy. Med Pharm Rep. 2019;92(2):200-204. PubMed PMID: 31086851.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bruising as the first sign of exocrine pancreatic insufficiency in infancy. AU - Szabo,Csilla Enikő, AU - Man,Oana Iulia, AU - Şerban,Radu Sorin, AU - Kiss,Eva, AU - Lazăr,Călin Florin, Y1 - 2019/04/25/ PY - 2018/11/12/received PY - 2019/01/21/revised PY - 2019/02/11/accepted PY - 2019/5/16/entrez PY - 2019/5/16/pubmed PY - 2019/5/16/medline KW - bruising KW - exocrine pancreatic insufficiency KW - malabsorption KW - steatorrhea KW - vitamin K deficiency SP - 200 EP - 204 JF - Medicine and pharmacy reports JO - Med Pharm Rep VL - 92 IS - 2 N2 - Exocrine pancreatic insufficiency is an important cause of chronic malnutrition, secondary to maldigestion-malabsorption, which can be caused in children especially by cystic fibrosis, but also by other much rarer diseases. The case of a 6 months and 3 weeks old male pediatric patient is reported, who was admitted to the clinic for head and forearms bruising. Laboratory findings identified vitamin K deficiency as the cause of the cutaneous hemorrhagic syndrome. Further investigations revealed association of steatorrhea (which is a marker of fat malabsorption), iron-deficiency anemia and hypovitaminosis D, which had been produced by nutritional deficiencies caused by malabsorption syndrome. From the numerous disorders that could be associated with pancreatic insufficiency in children, the following conditions had been excluded: cystic fibrosis (mucoviscidosis), cow's milk protein intolerance, gluten-sensitive enteropathy (coeliac disease), Shwachman-Diamond syndrome, abetalipoproteinemia, etc. Based upon decreased levels of stool pancreatic elastase in repeated measurements, together with low serum lipase, the final diagnosis of exocrine pancreatic insufficiency was established. Treatment of this case consisted mainly in pancreatic enzyme replacement therapy, but also oral iron supplementation and dietary supplements with fat-soluble vitamins (A, D, E, K). The outcome was favorable, characterized by normalization of intestinal passage, ascending growth curve and normalization of the majority of laboratory tests values that were modified between the time of patient admission to our clinic and initiation of specific therapy (serum level of vitamin K, vitamin D and lipase, coagulation profile, hemoglobin and red blood cell indexes), as well as higher value of fecal pancreatic elastase. SN - 2668-0572 UR - https://www.unboundmedicine.com/medline/citation/31086851/Bruising_as_the_first_sign_of_exocrine_pancreatic_insufficiency_in_infancy L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31086851/ DB - PRIME DP - Unbound Medicine ER -