Eosinophilic gastroenteritis with negative endoscopic biopsy and no peripheral eosinophilia: A case report

Abstract

Rationale: Eosinophilic gastroenteritis (EoGE) is a rare inflammatory disease that can affect the entire gastrointestinal tract. Klein et al classified EoGE into 3 distinct subtypes according to the depth of eosinophilic infiltration: mucosal, muscular, and serosal.

Patient concerns: We herein report a case of a 29-year-old woman who presented with abdominal pain, nausea, and vomiting, with no history of adverse reactions to any allergens. Laboratory test results revealed a normal count of peripheral blood eosinophils. Ultrasound and computed tomography revealed thickened intestinal walls and ascites in both the abdominal cavity and the pelvic cavity. Multiple endoscopic biopsies targeting several swelling segments of the intestinal wall revealed no increase in the number of eosinophils.

Diagnoses: The constellation of clinical, laboratory, radiological findings, histopathological data, and the excellent response to corticosteroids led to a diagnosis of EoGE for the patient.

Interventions: The patient was treated with corticosteroids.

Outcomes: Symptoms improved rapidly, and the thickened intestinal walls returned to a typical level.

Lessons: EoGE should be considered scrupulously, even if the count of eosinophils is in the normal range and the endoscopic biopsy is negative. Obtaining pathology of ascites as much as possible and taking a multisite biopsy sample, including both targeted and random biopsies, may improve the diagnostic rate.

Keywords: ascites; biopsy; diagnosis; eosinophilic gastroenteritis.

Figure 1.

Ultrasound images. Ultrasound showed ascites in the both abdominal cavity and pelvic cavity.

Figure 2.

Abdominal computed tomography scan images: (A) demonstrated diffuse thickening and edema involving the gastric antrum, duodenum and partial small intestinal; (B) demonstrated thickening and edema of the ascending colon.

Figure 3.

Endoscopic appearance. Colonoscopy results showed extensive swelling of the intestinal wall.

Figure 4.

Histological examination. Biopsies results showed eosinophilic infiltration <20 eosinophiles per high-power field. Hematoxylin and eosin stain.

Figure 5.

The pathology smear of ascites showed significant eosinophilic infiltration. Hematoxylin and eosin stain.