Jiang Huan-Huan, Tang Qing, Huang Li, Yun Xiang, Shan Qing-Wen, Chen Xiu-Qi
Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
World J Clin Cases. 2025 May 16;13(14):104039. doi: 10.12998/wjcc.v13.i14.104039.
Upper gastrointestinal hemorrhage is a life-threatening manifestation of cow's milk protein allergy (CMPA). We analyze the clinical characteristics of a case of milk protein allergy manifested as severe upper gastrointestinal hemorrhage.
The hospital admitted a 2-month-old male infant due to "melena for 6 days, hematemesis twice". The main symptom was melena, initially occurring once or twice per day, then gradually increasing to five or six times per day at their peak. During the course of the illness, the infant vomited blood, but there were no reports of vomiting, fever, pale complexion, dyspnea, wheezing, or difficulty breathing. Laboratory tests showed hemoglobin level of 87 g/L, platelet count of 349 × 10/L, and eosinophil percentage of 0.031. Coagulation studies were normal. After avoiding certain foods and feeding with an amino acid formula for 2 weeks, a repeat gastroscopy revealed less bleeding. After six weeks, a positive oral food challenge test confirmed a severe CMPA. At the 4-month follow-up, there was no gastrointestinal bleeding, and the infant was growing and developing well.
The manifestations of milk protein allergy are diverse and nonspecific, with gastrointestinal bleeding being less common, especially in infants. When infants present with unexplained massive hematemesis, it's critical to investigate the possibility of CMPA.
上消化道出血是牛奶蛋白过敏（CMPA）的一种危及生命的表现形式。我们分析了一例以严重上消化道出血为表现的牛奶蛋白过敏病例的临床特征。
该医院收治了一名2个月大的男婴，因“黑便6天，呕血2次”入院。主要症状为黑便，最初每天出现一两次，随后逐渐增加，在高峰期每天达五六次。在病程中，婴儿出现呕血，但无呕吐、发热、面色苍白、呼吸困难、喘息或呼吸急促的报告。实验室检查显示血红蛋白水平为87 g/L，血小板计数为349×10/L，嗜酸性粒细胞百分比为0.031。凝血研究正常。在避免某些食物并使用氨基酸配方奶喂养2周后，再次胃镜检查显示出血减少。六周后，口服食物激发试验呈阳性，证实为重度CMPA。在4个月的随访中，未出现胃肠道出血，婴儿生长发育良好。
牛奶蛋白过敏的表现多样且无特异性，胃肠道出血较为少见，尤其是在婴儿中。当婴儿出现不明原因的大量呕血时，调查CMPA的可能性至关重要。
