1 Case Records of the Massachusetts General Hospital Case 23-2017 — A 9-Day-Old Girl with Vomiting, Acidosis, and Azotemia Jason M. Shapiro, M.D., Rene Balza, M.D., Navneet K. Virk Hundal, M.D., Paul E. Hesterberg, M.D., and Lawrence R. Zukerberg, M.D. N Engl J Med Volume 377(4):372-383 July 27, 2017

2 Summary A 9-day-old girl was admitted to this hospital because of vomiting, decreased oral intake, and decreased activity. On examination, she appeared to be dehydrated; laboratory evaluation revealed metabolic acidosis and azotemia. A diagnosis was made.

3 Imaging Studies. Shapiro JM et al. N Engl J Med 2017;377:372-383

4 Gastrointestinal-Biopsy Specimens (Hematoxylin and Eosin). Shapiro JM et al. N Engl J Med 2017;377:372-383

5 Laboratory Data. Shapiro JM et al. N Engl J Med 2017;377:372-383

6 Final Diagnosis Food protein–induced enterocolitis syndrome.