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Case Reports
. 2022 Apr 28;22(1):209.
doi: 10.1186/s12876-022-02274-1.

Eosinophilic enteritis accompanied by cytomegalovirus disease: a case report

Yuichi Yamaga  1 , Masahiro Mizuno  2   3 , Shunji Okae  2   4 , Mikako Nio-Tamaoki  2 , Kenji Masuo  2 , Yoko Mashimo-Matsuo  5 , Junya Tanaka  2 , Motoshige Nabeshima  2
Affiliations
Case Reports

Eosinophilic enteritis accompanied by cytomegalovirus disease: a case report

Yuichi Yamaga et al. BMC Gastroenterol. .

Abstract

Background: Eosinophilic enteritis is a chronic inflammatory disorder of the intestinal tract that is characterized by eosinophil infiltration. Cytomegalovirus (CMV), a common virus, has a broad infectivity range. CMV is retained in the host body after infection. Impairment of host immune defences may reactivate the latent CMV, leading to symptoms of overt disease.

Case presentation: A Japanese female in her 70 s was admitted to a hospital due to diarrhoea and then transferred to our hospital. Laboratory data showed hypoalbuminemia. Computed tomography (CT) revealed oedema of the small intestine. Lower gastrointestinal endoscopy revealed oedema of the submucosa, without any remarkable changes in the mucosa of the terminal ileum. Histological examination of the terminal ileum revealed infiltration of > 20 eosinophils per high-power field (HPF). These findings aided in diagnosing eosinophilic enteritis. We administered methylprednisolone (500 mg/day) for three days, followed by tapering prednisolone. However, the patient's general condition and hypoalbuminemia failed to improve. Immunoglobulin (Ig) G- CMV and IgM-CMV tests were positive. CMV antigenemia was extremely high. Therefore, we administered ganciclovir intravenously, which improved the patient's condition. Furthermore, azathioprine was administered to taper and discontinue prednisolone without relapse of eosinophilic enteritis. This treatment helped stabilize the patient's condition for approximately four years.

Conclusion: We present a case of eosinophilic enteritis accompanied by CMV disease during prednisolone treatment. The patient's condition improved after administration of ganciclovir. Azathioprine aided in discontinuing prednisolone and stabilizing the patient's condition for approximately four years.

Keywords: Cytomegalovirus; Eosinophilic gastrointestinal disorders; Thiopurine.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A Lower gastrointestinal endoscopy. Lower gastrointestinal endoscopy revealed oedema of the submucosa without any remarkable change in the mucosa in the terminal ileum. B Hematoxylin and eosin staining of the terminal ileum, low-power field. Scale bar, 20 µm. C Hematoxylin and eosin staining of the terminal ileum, high-power field (HPF). The histological examination showed the infiltration of > 20 eosinophils per HPF. Scale bar, 20 µm
Fig. 2
Fig. 2
A Chest radiography. Chest radiography revealed massive pleural effusion. B Plain computed tomography (CT) upon transfer to our hospital. CT revealed massive pleural effusion, some ascites, and the thickening of the wall of the small intestine
Fig. 3
Fig. 3
Clinical course
Fig. 4
Fig. 4
Plain computed tomography (CT) on discharge. CT revealed decreased pleural effusion and ascites and improved of wall thickening of the small intestine
See this image and copyright information in PMC

References

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