A Case of Eosinophilic Gastroenteritis with Ascites

Abstract

Eosinophilic gastroenteritis is a rare disorder of unknown cause characterized by focal or diffuse eosinophilic infiltration of gastrointestinal tract, especially the stomach and duodenum. Its clinical presentation depends on which segment of gastrointestinal tract is affected and on the depth of eosinophilic infiltration in the affected segment. We present a case of a 35-year-old male with abdominal distention for six months. Laboratory testing revealed elevated eosinophil count and serum immunoglobulin E (IgE) levels. In abdominal tomography, ascites was observed, and eosinophilic infiltration was detected in duodenum biopsy samples, collected during endoscopic examination of upper gastrointestinal system. Clinical and pathologic findings of the patient responded to steroid dramatically. Even though their comorbidity is rare, eosinophilic gastroenteritis should be considered in differential diagnosis of patients with unspecified ascites.

Figure 1

(a) Abdominal CT with oral and intravenous contrast demonstrated ascites in perisplenic and perihepatic area (white arrow). (b) Image study shows multiple segment of small bowel wall thickening (white arrow head).

Figure 2

(a) Endoscopy reveals concentric rings (felinization). (b) Mucosal biopsy showed eosinophilic microabscess in the squamous epithelium (H&E stain, ×200). (c) Endoscopic examination showed extensive congestion and edema in duodenum. (d) Mucosal biopsy demonstrated eosinophilic infiltration with inflammatory cells in the lamina propria and submucosa (H&E stain, ×200). (e) On the follow-up endoscopy after 3 months, the duodenal mucosal congestion and edema are improved. (f) Biopsies were obtained at follow-up endoscopy that shows normal mucosal architecture (H&E stain, ×200).