Rice enterocolitis with growth hormone deficiency

Abstract Undiagnosed food hypersensitivity is one of the important treatable causes of growth failure in children. Anyhow, growth retardation in a child with known food hypersensitivity who has been on appropriate diet needed to be evaluated thoroughly. Rice is considered to be hypoallergenic and hypersensitivity to rice is rare and maybe difficult to diagnosed if the child has continuously ingested rice on daily basis. We reported a case of rice enterocolitis and growth hormone deficiency as co-existing causes of failure to thrive. Case report A 9-month-old male infant presented with failure to thrive and recurrent diarrhea. He developed recurrent vomiting and diarrhea when he was six months old. His growth rate had been declined and his development was delayed. Prick skin test revealed negative results to cow's milk, egg, wheat and rice. He was initially placed on elimination diet containing extensive hydrolysated formula and rice without any improvement. When rice was eliminated from his diet, there was subsequent improvement in vomiting and diarrhea. Double blind, placebo-controlled food challenge with rice confirmed the diagnosis of rice enterocolitis. Despite the improvement in vomiting and diarrhea, his growth had not been normalized. Evaluation for growth hormone found low level of IGFBP-3 (261.58 ng/ml, normal 2873+/-725.1). Recombinant growth hormone was given and resulted in marked improvement of growth rate. Conclusion Food hypersensitivities caused by food considered hypoallergenic, such as rice, can escape diagnosis. Patient with food hypersensitivity who is still having growth retardation despite appropriate diet should be thoroughly evaluated for other possible co-existing causes.