A female infant, delivered via cesarean section at 38 weeks of gestation following an uneventful pregnancy, required only routine postnatal care. The infant was discharged on her second day post-birth, exclusively breastfeeding.
At two months of age, the infant was evaluated for persistent regurgitation episodes, inadequate weight gain and irritability during feeding. A diagnosis of gastroesophageal reflux disease (GERD) was established and treatment was initiated with a liquid dispersion of esomeprazole (1.5 mg daily), prepared from crushed solid dosage forms.
At three months, the infant presented to the emergency department after two episodes of vomiting with visibly purple gastric contents (Figure 1). Caregivers reported no other concerning symptoms and the infant's physical examination revealed no abnormalities. Laboratory tests and imaging studies ruled out potential differential diagnoses, such as upper gastrointestinal bleeding or metabolic disorders.
The compounded esomeprazole formulation was promptly discontinued and therapy was transitioned to esomeprazole gastro-resistant granules for oral suspension. Within days, the purple discoloration of gastric contents ceased and subsequent follow-ups confirmed the resolution of regurgitation symptoms and adequate weight gain.
Figure 1. Purple regurgitated gastric contents around the mouth and neck region.
What is the cause?