Eosinophilic gastrointestinal disorder in coeliac disease: a case report and review

Abstract

Eosinophilic gastrointestinal disorder is a rare disorder characterised by eosinophilic infiltration of the gastrointestinal tract. There are various gastrointestinal manifestations with eosinophilic ascites being the most unusual and rare presentation. Diagnosis requires high index of suspicion and exclusion of various disorders associated with peripheral eosinophilia. There are no previous case reports to suggest an association between eosinophilic gastrointestinal disorder and coeliac disease in adults. We report a case of eosinophilic ascites and gastroenteritis in a 30-year-old woman with a known history of coeliac disease who responded dramatically to a course of steroids.

Figure 1

Computed tomography of abdomen and pelvis showing large amount of ascites and thickened small bowel wall. No pelvis or peritoneal mass identified.

Figure 2

Esophagogastroduodenoscopy showed multiple areas of erythematous patches at the duodenal bulb.

Figure 3

H&E Low power view of second part of duodenal biopsy showing Marsh 3a villous atrophy.

Figure 4

H&E high power view of jejunal biopsy showed increase in lamina propria cellularity with eosinophilic infiltration.

Figure 5

H&E section of jejunal biopsy showed eosinophils infiltration (30/HPF) in the lamina propria.

Figure 6

Computed tomography showing resolution of ascites and small bowel thickening three months after discharge from hospital.