Infantile-onset inflammatory bowel disease (IOIBD) is an IBD that presents in children <2 years of age. It is very rare, and sometimes, the condition is challenging to diagnose as the characteristic diagnostic features may not be present at the time of the initial assessment. Often, they present with an aggressive phenotype requiring escalating treatment regimens and intense nutritional rehabilitation. Here, we discuss a case where the infant presented with symptoms, signs, and endoscopic features suggestive of IBD; however, the histology was not supportive. In this case, allergic colitis was the closest differentials considered. The child required steroids for induction therapy and was also started on mesalazine. The child had a flare of symptoms after the initial course of steroids was stopped and required reinduction with steroids and immunomodulator azathioprine as maintenance therapy. The genetic evaluation has been inconclusive so far. We discuss the possible differential diagnosis considered and the relevant literature.
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