A 32-year-old Caucasian woman, with no relevant medical history, was admitted to the Emergency Department due to generalized abdominal pain, nausea, postprandial infarction, diarrhea, and enlargement of abdominal perimeter, lasting 3 weeks. She reported an aggravation in the last 3 days. She denied other symptoms, including fever, night sweats, weight loss, arthralgia, or skin rash, as well as history of atopic diseases, food allergies, raw fishing eating, or recent medication intake.
On examination she had painful and distended abdomen. The cardiopulmonary examination was normal. Blood tests revealed leukocytosis [13360/microliter (mul)] with 36.5% of eosinophils (4880/mul). The abdomen X-ray showed levels in the upper right quadrant (Figure 1).
Abdominal CT scan revealed diffuse and concentric parietal thickening of the distal two-thirds of esophagus, moderate volume ascites, and small bowel wall thickening with distension on the left quadrants (Figure 2)
The gastroscopy showed a "peptic ring at 40 cm and hyperemia of the body and antrum mucosa"; no biopsies were taken (Figures 3 and 4). She was admitted to the Internal Medicine Department for complementary study. The abdominal ultrasound showed several dilated loops in the small bowel, with significant reduction of their peristalsis, compatible with intestinal subocclusion. The parasitological stool exam was negative for eggs, cysts, and parasites. Serum IgE level was normal (83.8 KU/L).
The patient underwent an ultrasound-guided paracentesis. Results showed 6912 leukocytes/mm3, of which 93.3% were eosinophils (6450/mul), without malignancy; laboratory testing of the ascitic fluid for bacterial culture and tuberculosis was negative.
Colonoscopy showed a congestive and petechial ileocecal valve and hypotrophic mucosa with evidence of submucosal circulation, suspected of microscopic colitis. Colon biopsies showed mucosa with nodular lymphoid hyperplasia and increased number of eosinophils/high power microscopic fields in left colon (20-24/high power microscopic fields) (Figure 5).
The constellation of clinical, analytical, and histopathological results suggested the diagnosis of eosinophilic gastroenteritis.
The patient was started on 40 mg of oral prednisolone/day, with clinical and analytical rapid improvement (decrease of 5130 eosinophils/uL to 100 eosinophils/uL with 2 doses of prednisolone). To date, the patient stopped taking corticosteroids and remains asymptomatic.