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Case Reports
. 2021 Feb 4;14(2):e240039.
doi: 10.1136/bcr-2020-240039.

Vitamin D deficiency causing eosinophilic esophagogastroenteritis and ascites: a rare association

Choon-Seng Qua  1 , Kaik-Boo Peh  2 , Kannan Saravannan  1 , Khean-Lee Goh  3
Affiliations
Case Reports

Vitamin D deficiency causing eosinophilic esophagogastroenteritis and ascites: a rare association

Choon-Seng Qua et al. BMJ Case Rep. .

Abstract

A 54-year-old Chinese man presented with ascites for 2 weeks. He had a preceding 2-year history of intermittent dysphagia, lethargy and general malaise. Blood investigations revealed leucocytosis with eosinophilia of 26.5%, whereas paracentesis showed turbid fluid with high protein content (45 g/L) and a high white blood cell count of 5580/µL, predominantly eosinophils (90%). An incidental assay of vitamin D showed a very low level of 13.5 ng/mL. No other cause of ascites was found. Gastroscopy was normal except for duodenitis. However, biopsies from lower oesophagus confirmed the presence of eosinophilic infiltration. Following vitamin D replacement, the patient experienced marked improvement in symptoms of dysphagia within 2 weeks and no recurrence of ascites after 3 months. The reason for the patient's vitamin D deficiency remains unclear. The marked improvement in the patient's health indicates a causative role of vitamin D deficiency in causing eosinophilic esophagogastroenteritis and associated eosinophilic ascites.

Keywords: immunology; small intestine; stomach and duodenum.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
A CT scan showing (A) thickening of the lower oesophagus, (B) thickening of the antrum and first part of the duodenum and (C) thickening of the upper jejunum (arrow).
Figure 2
Figure 2
Ascitic fluid showing eosinophils (arrow).
Figure 3
Figure 3
Endoscopic view of the (A) lower oesophagus and (B) first part of the duodenum showing mucosal oedema and thickening.
Figure 4
Figure 4
Histological picture of a biopsy of the lower oesophagus showing eosinophilic infiltration (arrow) (×40 magnification, H&E stain).
Figure 5
Figure 5
A CT scan showing resolution of the swelling of the (A) lower oesophagus, (B) antrum and (C) first part of the duodenum and proximal jejunum following vitamin D supplementation.
Figure 6
Figure 6
Histological picture of biopsy of the lower oesophagus showing complete resolution of the eosinophilic infiltration following vitamin D supplementation (×40 magnification, H&E stain).
See this image and copyright information in PMC

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