Persistent Unexplained Diarrhea in a 4-Month-Old Infant: A Case Report from a Limited-Resource Setting

Background: Persistent diarrhea in young infants is a significant contributor to morbidity and mortality in low-resource settings. Etiologies are diverse, including infectious, immunological, and metabolic causes. However, diagnostic limitations often obscure the underlying pathology.


Case Summary: We report the case of a 4-month-old female infant with persistent watery diarrhea since the neonatal period, unresponsive to empirical treatments. Initial findings included severe hypernatremia, hyperkalemia, azotemia, and elevated liver enzymes. Stool tests revealed reducing substances, suggestive of carbohydrate malabsorption. Despite multiple dietary trials and supportive care, the infant failed to thrive. Differential diagnoses included secondary lactose intolerance, cow’s milk protein allergy, immunodeficiency, and rare congenital enteropathies. Referral to a tertiary center was recommended, but a definitive diagnosis could not be achieved due to limited diagnostic resources.


Conclusion: This case highlights the challenges of managing persistent infantile diarrhea in low-resource settings and underscores the need for simplified diagnostic algorithms, provider training, and expanded access to tertiary care.