Protein-losing enteropathy in a patient on ketogenic diet for limbic encephalitis: Treatment effect or underlying pathology?

To the Editor:
Recently, Moriyama et al.1 reported a girl with onset of limbic encephalopathy at age 9 years associated with a 5-day prodrome of pyrexia of unknown origin. Her seizures remained refractory to multiple antiepileptic drug therapies and a ketogenic diet was initiated on the 15th day of symptoms. Progressive weight loss led to identification of protein-losing enteropathy, investigated by endoscopy, enteral biopsy, and nuclear medicine imaging. The authors cite one other patient in the literature with a ketogenic diet-associated protein-losing enteropathy and hypothesize a causative role of ketogenic diet in the protein-losing enteropathy