Eosinophilic gastroenteritis with eosinophilic dermatitis

Abstract

Eosinophilic gastroenteritis (EG) is characterized by eosinophilic infiltration of the bowel wall and variable gastrointestinal manifestations. Clinicians should have a high index of suspicion for EG when faced with gastrointestinal symptoms and peripheral eosinophilia to avoid incorrect diagnosis and inappropriate treatments. A 24-year-old woman was admitted to our hospital complaining of acute right lower quadrant abdominal pain and a laparoscopic appendectomy performed for a presumed diagnosis of an acute appendicitis. However, the procedure revealed bowel edema and a moderate amount of ascites without evidence of a suppurative appendicitis. Postoperatively, she showed persistent and progressive eosinophilia, exudative eosinophilic ascites, eosinophilic infiltration of the resected appendix wall, and eosinophilic infiltration of gastroduodenal mucosa. A punch biopsy of the abdominal skin also revealed inflammation with marked eosinophilic infiltration of the skin. She recovered after the treatment with a low dose of steroid for the EG with eosinophilic dermatitis. EG with eosinophilic dermatitis has not been reported yet and is considered fortuitous in this case.

Keywords: Eosinophil; ascites; corticosteroids; dermatitis; gastroenteritis.

Fig. 1

Microscopic findings of the resected appendix showed a diffuse eosinophilic infiltration from the muscular layer to the subserosal layer of the appendix wall (H&E stain, A: ×40 and B: ×400).

Fig. 2

Microscopic examination of the gastric antrum (A: H&E stain, ×400) and duodenum (B: H&E stain, ×400) showed inflammation with eosinophilic infiltration. Extracellular eosinophilic staining constituents were observed in the lamina propria.

Fig. 3

A punch biopsy of the abdominal skin revealed perivascular and interstitial inflammation with marked eosinophilic infiltration from the dermis to the subcutaneous fatty layer (H&E stain, ×400).