Heiner Syndrome (HS) is a rare non-IgE mediated hypersensitivity
reaction to cow’s milk resulting in chronic respiratory disease due to
pulmonary hemorrhage. Heiner et al. first described this entity in 1962
after identifying cow’s milk precipitins (immunoglobulin G to milk
antigens) in the sera of seven children with chronic respiratory
symptoms and infiltrates on chest radiograph 2.
Associated findings include gastrointestinal symptoms, anemia, recurrent
fever, and growth faltering. Removal of milk protein from the diet leads
to symptom resolution and reversal of chest radiograph findings.
Children with HS often experience delays in diagnosis given its rarity,
chest imaging that can mimic infectious pneumonia, and variable clinical
and laboratory features 3. Milk precipitin testing,
for example, is not positive in all cases 4. Special
attention should be paid to chest radiography as a recent review of HS
cases found that pulmonary infiltrates were universal in this condition
(with the exception of one study that did not include radiography data)
5. The rapid evolution of the patient’s symptoms and
imaging, despite negative testing, highlight the importance of expanding
the differential diagnosis for patients with pulmonary infiltrates that
do not respond to typical treatments to include HS.