Failure of Fecal Microbiota Transplantation in a Three-Year-Old Child with Severe Refractory Ulcerative Colitis / 대한소아소화기영양학회지

Fecal microbiota transplantation (FMT) is a treatment designed to correct gut dysbiosis by administration of feces from a healthy volunteer. It is still unclear whether FMT for children with ulcerative colitis (UC) is effective or hazardous. Here we describe a young patient to have received FMT for UC. A three-year-old girl was admitted to our hospital with severe active UC, and treated with aminosalicylates and various immunosuppressive drugs. As remission was not achieved, we decided to try FMT before colectomy. We administered donor fecal material a total of six times by retention enema (×2) and via a nasoduodenal tube (×4) within 10 days. The patient developed abdominal pain and pyrexia after each FMT session. Analyses revealed the transferred donor fecal microbiota had not been retained by the patient, who ultimately underwent colectomy. The severity of the UC and/or timing of FMT may have partly accounted for the poor outcome.

Acute encephalopathy with callosal, subcortical and thalamic lesions

Acute encephalopathy is classified into multiple syndromes, such as acute encephalopathy with biphasic seizures and late reduced diffusion (AESD), clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) and acute necrotizing encephalopathy (ANE), characterized radiologically by lesions in the cerebral subcortical white matter, splenium of the corpus callosum and bilateral thalami, respectively. We described a previously healthy 8-year-old boy who had febrile and biphasic seizures, and encephalopathy. MRI showed abnormal signal intensity in the corpus callosum on day 2 and cerebral subcortical white matter and bilateral thalamic lesions on day 8. This is the first case of acute encephalopathy in which callosal, subcortical and thalamic lesions co-existed. The clinical course of this case was typical for AESD, atypical for MERS, and different from that of ANE.