ILEAL-LYMPHOID-NODULAR HYPERPLASIA, NONSPECIFIC COLITIS, AND PERVASIVE DEVELOPMENTAL DISORDER IN CHILDREN

Background We investigated a consecutive series of children with chron ic enterocolitis and regressive developmental disorder. Methods 12 chi ldren (mean age 6 years [range 3-10], 11 boys) were referred to a paed iatric gastroenterology unit with a history of normal development foll owed by loss of acquired skills, including language, together with dia rrhoea and abdominal pain. Children underwent gastroenterological, neu rological, and developmental assessment and review of developmental re cords. Ileocolonoscopy and biopsy sampling, magnetic-resonance imaging (MRI), electroencephalography (EEG), and lumbar puncture were done un der sedation. Barium follow-through radiography was done where possibl e. Biochemical, haematological, and immunological profiles were examin ed. Findings Onset of behavioural symptoms was associated, by the pare nts, with measles, mumps, and rubella vaccination in eight of the 12 c hildren, with measles infection in one child, and otitis media in anot her. All 12 children had intestinal abnormalities, ranging from lympho id nodular hyperplasia to aphthoid ulceration. Histology showed patchy chronic inflammation in the colon in 11 children and reactive ileal l ymphoid hyperplasia in seven, but no granulomas. Behavioural disorders included autism (nine), disintegrative psychosis (one), and possible postviral or vaccinal encephalitis (two). There were no focal neurolog ical abnormalities and MRI and EEG tests were normal. Abnormal laborat ory results were significantly raised urinary methylmalonic acid compa red with age-matched controls (p=0.003), low haemoglobin in four child ren, and a low serum IgA in four children. Interpretation We identifie d associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers.