title: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.
abstract: We investigated a consecutive series of children with chronic enterocolitis and regressive developmental disorder.
  
  
  
  12 children (mean age 6 years [range 3-10], 11 boys) were referred to a paediatric gastroenterology unit with a history of normal development followed by loss of acquired skills, including language, together with diarrhoea and abdominal pain. Children underwent gastroenterological, neurological, and developmental assessment and review of developmental records. Ileocolonoscopy and biopsy sampling, magnetic-resonance imaging (MRI), electroencephalography (EEG), and lumbar puncture were done under sedation. Barium follow-through radiography was done where possible. Biochemical, haematological, and immunological profiles were examined.
  
  
  
  Onset of behavioural symptoms was associated, by the parents, with measles, mumps, and rubella vaccination in eight of the 12 children, with measles infection in one child, and otitis media in another. All 12 children had intestinal abnormalities, ranging from lymphoid nodular hyperplasia to aphthoid ulceration. Histology showed patchy chronic inflammation in the colon in 11 children and reactive ileal lymphoid 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 neurological abnormalities and MRI and EEG tests were normal. Abnormal laboratory results were significantly raised urinary methylmalonic acid compared with age-matched controls (p=0.003), low haemoglobin in four children, and a low serum IgA in four children.
  
  
  
  We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers.
authors.affiliation: Inflammatory Bowel Disease Study Group, University Department of Medicine, Royal Free Hospital and School of Medicine, London, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Wakefield
authors.forename: S H
authors.initials: SH
authors.lastname: Murch
authors.forename: A
authors.initials: A
authors.lastname: Anthony
authors.forename: J
authors.initials: J
authors.lastname: Linnell
authors.forename: D M
authors.initials: DM
authors.lastname: Casson
authors.forename: M
authors.initials: M
authors.lastname: Malik
authors.forename: M
authors.initials: M
authors.lastname: Berelowitz
authors.forename: A P
authors.initials: AP
authors.lastname: Dhillon
authors.forename: M A
authors.initials: MA
authors.lastname: Thomson
authors.forename: P
authors.initials: P
authors.lastname: Harvey
authors.forename: A
authors.initials: A
authors.lastname: Valentine
authors.forename: S E
authors.initials: SE
authors.lastname: Davies
authors.forename: J A
authors.initials: JA
authors.lastname: Walker-Smith
mesh_terms: D002648:Child; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000209:etiology*; D004760:Enterocolitis / Q000209:etiology*; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000473:pathology; D007082:Ileum / Q000473:pathology*; D008221:Lymphoid Tissue / Q000473:pathology*; D008297:Male; D008457:Measles / Q000150:complications; D008458:Measles Vaccine / Q000009:adverse effects*; D022542:Measles-Mumps-Rubella Vaccine; D009108:Mumps Vaccine / Q000009:adverse effects*; D010033:Otitis Media / Q000150:complications; D012411:Rubella Vaccine / Q000009:adverse effects*; D017778:Vaccines, Combined / Q000009:adverse effects
chemical_list: D008458:Measles Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D009108:Mumps Vaccine; D012411:Rubella Vaccine; D017778:Vaccines, Combined