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Cow’s milk protein allergy in a neonate presenting with methaemoglobinaemia
  1. Simi Kurian1,
  2. Nalinikanta Panigrahy1,
  3. Vijayanand Jamalpuri2 and
  4. Dinesh Chirla1
  1. 1Department of Neonatology, Rainbow Children's Hospital, Hyderabad, India
  2. 2Rainbow Children's Hospital Banjara Hills, Hyderabad, India
  1. Correspondence to Dr Nalinikanta Panigrahy; nalini199{at}


Cow’s milk protein allergy (CMPA) is the most common food allergy in infants. A previously healthy neonate fed with infant formula presented diarrhoea, vomiting and respiratory distress with cyanosis. Investigations showed thrombocytosis and leucocytosis with lymphocyte predominance. To our surprise blood gas analysis showed metabolic acidosis and a high methaemoglobin level of 33% (normal range <3%). Clinical status, metabolic acidosis and methaemoglobin level returned to normal following fluid resuscitation and methylene blue administration. The neonate was later managed with breast feeding and elemental formula. CMPA was diagnosed based on history and clinical improvement after elemental formula. Although not common in CMPA, methaemoglobinaemia should be recognised as a differential diagnosis in a hypoxic infant with metabolic acidosis and diarrhoea as early recognition and treatment with methylene blue can save a child’s life.

  • gastrointestinal system
  • paediatrics (drugs and medicines)
  • haematology (incl blood transfusion)

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  • Contributors SK and NP wrote the initial draft of the manuscript. VJ and DC edited the manuscript. All authors approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.