Drug-induced enterocolitis syndrome (DIES) is a rare hypersensitivity reaction characterized by delayed gastrointestinal symptoms following ingestion of triggering medications. We report the case of a seven-year-old male presenting with symptoms consistent with DIES after receiving amoxicillin-clavulanic acid (AMX/CLV) for tonsillitis and soft tissue infection.

The patient experienced recurrent vomiting and lethargy 2-3 hours post-administration of AMX/CLV. Following supportive care and clarithromycin treatment, the symptoms resolved. Oral provocation testing with AMX/CLV resulted in severe abdominal pain, vomiting, and lethargy, confirming DIES. Patch testing with various beta-lactam antibiotics yielded negative results. Subsequent oral provocation with cefuroxime axetil showed no adverse reactions, suggesting an alternative.

This case highlights the importance of considering DIES as a differential diagnosis in patients presenting with delayed gastrointestinal symptoms following drug intake. Identifying alternative antibiotics is crucial for the management of such cases.