Case Presentation: A Pale Infant Boy With Dark Stools1
EB is a 10-month-old infant from rural India. He was delivered at full term but was small for gestational age. He presents with pallor and a 1-month history of dark stools. He is afebrile and continues to feed well.
EB's mother is a 29-year-old G4P4PT1LC3 whose last pregnancy resulted in a preterm infant who died on the first day of life. She has poor access to healthcare and had no prenatal care with her pregnancies. She reports that she was previously diagnosed with anemia. Her other 2 children have growth impairment.
On physical examination, EB is below the third percentile for both height and weight on World Health Organization (WHO) growth charts. He has notable pallor and tachycardia. His lungs are clear, and his abdomen is soft and nontender.
A melenic-appearing stool at the rectal vault is positive for occult blood. A complete blood count shows hemoglobin of 6.2 g/dL, total leukocyte count of 58,000 cells/mm3 with 42% eosinophils, and a normal platelet count. EB's prothrombin time and partial thromboplastin time, liver enzymes, and bilirubin levels are all normal. Thick and thin smears for malaria are negative, as is a Meckel scan.
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