Successful Montelukast Treatment in an Infant with Steroid-Resistant Eosinophilic Colitis

Abstract

Eosinophilic colitis (EC) belongs to a group of idiopathic diseases called eosinophilic gastrointestinal disorders, which are characterized by eosinophil-predominant inflammation in the gastrointestinal tract. Corticosteroids is the first-line pharmacotherapy for EC refractory to diet therapy. We report an infant with steroid-resistant EC, who successfully returned to a healthy growth trajectory under the combined therapy of montelukast and ketotifen. An 8-month-old boy presented with bloody diarrhea, anemia, and failure to thrive (FTT) that started 6 days after birth. The patient has no known allergies. A trial of elementary diet was unsuccessful. The results of several stool cultures were unremarkable. Similarly, lower gastrointestinal series failed to identify anything significant. At 3 months of age, an esophagogastroduodenoscopy with biopsies from the distal duodenum and proximal jejunum were unremarkable. The diarrhea and FTT persisted. A rectosigmoidoscopy with biopsies was performed; the results led to the diagnosis of EC at 5 months of age. Oral prednisolone 1 mg/kg/day was prescribed; however, 3 months into the treatment, persistent bloody diarrhea and FTT were still noted. Montelukast and ketotifen were added, after which diarrhea and weight gain started to improve. Prednisolone and montelukast/ketotifen were tapered off 6 months after. He remains symptom free and has normal growth and development in a 5-year follow-up.

Eosinophilic Colitis, an Uncommon Cause of Diarrhea: Case Report and Literature Review

“…In severe, refractory, or steroid-dependent EC immunomodulatory drugs like those indicated for inflammatory bowel disease such as azathioprine or 6-mercaptopurine might be used [11]. The possibility of using montelukast, a leukotriene receptor antagonist, as a steroid-sparing therapy was also raised, and there are some studies and case reports that support its efficacy [15, 16]. Other drugs can also be used in the treatment of EC, namely, antihistamines such as ketotifen; mast cell stabilizers such as sodium cromoglycate; biological agents such as omalizumab and mepolizumab, all with varying proved efficacy [11].…”

A rare case of eosinophilic gastrointestinal disorders with short bowel syndrome after strangulated bowel obstruction

“…Fundamentally, the treatment strategy for secondary EGIDs is to treat the primary disease; however, it was difficult to improve the digestive symptoms using only nutritional therapy in our case. Several studies have reported montelukast sodium as an effective treatment for EGIDs [11,12]. Montelukast is a selective and competitive of the cysteinyl leukotriene receptor.…”