Eosinophilic enteritis: the great mimic

Abstract

Eosinophilic enteritis (EoN), a subtype of eosinophilic gastrointestinal disease, is a rare and complicated inflammatory condition affecting the small intestine. This case report discusses a 42-year-old patient who presented with acute gastrointestinal symptoms including diarrhea, nausea, and vomiting. Initial laboratory investigations revealed leukocytosis, peripheral eosinophilia, and distinctive imaging findings, prompting further evaluation. Endoscopic evaluation revealed extensive mucosal lesions in the small intestine, with subsequent biopsies confirming eosinophilic infiltration, ultimately leading to the diagnosis of chronic enteritis, probably of an eosinophilic nature. The case highlights the complex differential diagnostic process involved in identifying EoN, which requires a comprehensive understanding of all the clinical and histopathological features of the disease. The efficacy of budesonide therapy is also discussed in the management of EoN and it was evidenced by our patient's positive response to treatment. This case report contributes significant insights into the understanding and management of EoN, providing essential information for the medical community to facilitate accurate diagnosis and tailored therapeutic interventions for individuals experiencing this complex disorder.

Keywords: budesonide treatment; chronic inflammatory disorder; endoscopic evaluation; eosinophilic enteritis; eosinophilic infiltration.

Fig. 1

Aspect from the endoscopic videocapsule: A: edematous mucosa; B: diffuse congestive appearance of the villi, including a pavement appearance, or suggesting infiltration; C: areas with bleeding, blood coming from ulcerated areas or red blood in the lumen; D: protruding areas with modified, congestive, fissured mucosa, superficial, linear or irregular ulcers; E: polypoid areas separated by fibrin-based ulcers, evoking “paving stone”; F: stenosed areas due to the presence of the described protrusive/polypoid lesions.