Eosinophilic gastroenteritis presenting as upper gastrointestinal hematoma and ulcers after endoscopic biopsy: A case report and literature review

Abstract

Rationale: Eosinphilic gastroenteritis (EG) is a gastrointestinal disorder characterized by eosinophilic infiltration with various manifestations. The diagnosis is usually confirmed by an endoscopic biopsy, which is considered a safe and routine procedure for the majority.

Patient concerns: We report a 54-year-old male who was presented with intermittent periumbilical pain and melena, and only revealed verrucous gastritis by endoscopy.

Diagnoses: The patient's condition worsened two days after the endoscopic biopsy, and another endoscopy found hematoma and ulcers in upper gastrointestinal tract. He was diagnosed with EG by the pathological analysis of biopsy specimen.

Interventions: Oral methylprednisolone and Montelukast were prescribed.

Outcomes: The patient got remission after initiation of the treatment.

Lessons: This case highlights an extremely rare but potentially severe complication of endoscopic biopsies in patients with EG. Physicians should be cautious with hematoma or ulceration, and consider it in such patients who undergo this procedure.

Figure 1

(A and B) Initial upper gastrointestinal endoscopy only showed verrucous gastritis. (C) The second endoscopy four days later revealed swollen and inflamed mucosal changes with gastric hematoma and (D) multiple ulcers in the stomach and duodenum. (E and F) The endoscopy after 3 months found great improvement in lesions of both stomach and duodenum.

Figure 2

(A) Pathological examination of first biopsy showed gastric mucosa with extensive eosinophilic infiltrate in the lamina propria. (B) Analysis of biopsy 3 months later demonstrated a large proportion of clearing of the eosinophilic infiltration (H&E staining, ×200).