Subserous Eosinophilic Colitis: A Case Report in a Private Hospital in Lima, Peru

Eosinophilic colitis is a rare gastrointestinal disease that belongs to the group of so-called primary eosinophilic diseases of the digestive tract. There are three types: mucosa, transmural (muscular), and subserous. We present the case of a 23-year-old male patient with a clinical picture of abdominal pain, nausea, chronic diarrhea, and ascites. Parasitic and other secondary etiologies were ruled out. Upper digestive endoscopy was not helpful. Colonoscopy revealed characteristics of inflammation in the distal ileum and ascending colon, the histological findings of which were consistent with eosinophilic colitis. The study of ascitic fluid was suggestive of eosinophilic ascites. The patient received induction treatment with prednisone 40 mg daily orally; remission was achieved after two weeks, and maintenance therapy based on prednisone was continued with the progressive withdrawal of the dose. Control of the disease was successful.

La colitis eosinofílica es una patología gastrointestinal infrecuente que pertenece al grupo de las denominadas enfermedades primarias eosinofílicas del tracto digestivo. Existen 3 tipos: mucosa, transmural (muscular) y subserosa. Presentamos el caso de un paciente varón, de 23 años de edad, con un cuadro clínico de dolor abdominal, náuseas, diarrea crónica y presentación de ascitis. Se descartan etiologías parasitarias y otras secundarias. La endoscopia digestiva alta no fue contribuidora. Mediante una colonoscopia se observaron características de inflamación en el íleon distal y el colon ascendente, cuyos hallazgos histológicos son compatibles con colitis eosinofílica. El estudio de líquido ascítico es sugestivo de ascitis eosinofílica. El paciente recibió tratamiento de inducción con prednisona a 40 mg diarios por vía oral, se logró la remisión a las 2 semanas y se continuó con terapia de mantenimiento a base de prednisona con retiro progresivo de la dosis. Se logró el control de la enfermedad de manera exitosa.

Causas infrecuentes de ascitis: Reporte de 5 casos / Uncommon causes of ascites: Report of 5 cases

Introducción: La ascitis se define como la presencia de líquido en la cavidad peritoneal. La etiología más común la constituyen las enfermedades hepáticas que cursan con hipertensión portal, dentro de ellas la cirrosis hepática reportada en un 40 por ciento, a 5 años de seguimiento de los casos. Estudios previos muestran que la ascitis por enfermedad cirrótica hepática es entre un 80-85 por ciento, también la carcinomatosis se presenta en un 10 por ciento, y dentro de las causas más raras están la insuficiencia cardiaca y la tuberculosis peritoneal en un 3 por ciento, junto con la trombosis de la vena porta, sarcoidosis, tumores intraperitoneales, ascitis pancreática y la enteritis eosinofílica. Objetivo: Describir presentaciones clínicas infrecuentes como causa de ascitis en pacientes hospitalizados en el Hospital Clínico Quirúrgico Hermanos Ameijeiras. Presentación de casos: Se presentan cinco casos que ingresaron en el Hospital Hermanos Ameijeiras con diagnóstico de Ascitis: quilosa, hemorrágica, eosinofílica y coloide, con las patologías que los llevaron a esa manifestación clínica y una breve descripción de la misma. Conclusión: El análisis de las presentaciones clínicas de los casos, los hallazgos en los estudios imagenológicos y en los exámenes de laboratorio, así como los resultados anatomopatológicos permitieron el diagnóstico de las entidades causantes de ascitis atípicas en estos pacientes(AU)

Introduction: Ascites is defined as the presence of fluid in the peritoneal cavity. The most common etiology is liver diseases with portal hypertension; among them liver cirrhosis is reported in 40 percent of cases with 5-year follow-up. Previous studies demonstrate that ascites due to cirrhotic liver disease occurs in 80-85 percent of the cases, that carcinomatosis is also present in 10 percent, and also that among the rarest causes, heart failure and peritoneal tuberculosis are present in 3 percent of cases along with portal vein thrombosis, sarcoidosis, intraperitoneal tumors, pancreatic ascites and eosinophilic enteritis. Objective: To describe uncommon clinical presentations as cause of ascites in patients admitted to Hermanos Ameijeiras Clinical Surgical Hospital. Case presentation: Five cases of patients admitted to Hermanos Ameijeiras Clinical Surgical Hospital with the diagnosis of ascites: chylous, hemorrhagic, eosinophilic and colloid as well as the pathologies that led them to this clinical manifestation and a brief description of it are presented. Conclusion: The analysis of the clinical presentation of the cases, the findings in the imaging studies and laboratory tests and the anatomopathological results allowed the diagnosis of the entities causing atypical ascites in these patients(AU)

Eosinophilic Enteritis with Eosinophilic Ascites without Eosinophilia / 이화의대지

Eosinophilic enteritis is an uncommon disease of unknown cause characterized by eosinophilic infiltration in various areas of the gastrointestinal tract with symptoms. It is generally classified according to the layer of the gastrointestinal tract involved. Eosinophilic infiltration of the serosa is the rarest form of presentation and may manifest eosinophilic ascites. We report a case of a 47-year-old man who experienced progressing abdominal pain. A diffuse erythematous change of the gastric mucosa was observed on gastrofibroscopy. An abdominal computed tomography and colonoscopy showed diffuse wall thickening of the small bowel and colon with a small amount of ascites. Eosinophilic infiltration was confirmed by multiple biopsies of the gastrointestinal tract and peritoneal fluid analysis. The patient was treated with corticosteroid and responded dramatically.

Eosinophilic Enteritis with Eosinophilic Ascites without Eosinophilia / 이화의대지

Eosinophilic enteritis is an uncommon disease of unknown cause characterized by eosinophilic infiltration in various areas of the gastrointestinal tract with symptoms. It is generally classified according to the layer of the gastrointestinal tract involved. Eosinophilic infiltration of the serosa is the rarest form of presentation and may manifest eosinophilic ascites. We report a case of a 47-year-old man who experienced progressing abdominal pain. A diffuse erythematous change of the gastric mucosa was observed on gastrofibroscopy. An abdominal computed tomography and colonoscopy showed diffuse wall thickening of the small bowel and colon with a small amount of ascites. Eosinophilic infiltration was confirmed by multiple biopsies of the gastrointestinal tract and peritoneal fluid analysis. The patient was treated with corticosteroid and responded dramatically.

Spontaneous remission of eosinophilic ascites in a young patient / Remissão espontânea de ascite eosinofílica em um paciente jovem

Um homem de 22 anos apresentou dor abdominal e ascite, perda de peso e febre (37,9ºC). Negou antecedente de atopia, tabagismo, etilismo e uso de drogas. Estudo das imagens obtidas por ultrassonografia e tomografiacomputadorizada de abdome revelou moderada ascite, e as alças do intestino delgado encontravam-se distendidas e espessadas. O hemograma mostrou leucocitose (10.700/mm3) e eosinofilia (23%). O exame do líquido ascítico revelou elevada contagem de leucócitos (1.601/mm3) com acentuada eosinofilia (93%), além de ausência de microorganismos, parasitas ou células malignas. A avaliação laparoscópica e endoscópica com estudos de biópsiasdescartou a hipótese de gastroenterite eosinofílica e outros diagnósticos diferenciais. O paciente recebeu suporte clínico, sem a utilização de corticosteroides, apresentando evolução clínica favorável.

A 22 year-old man presented with abdominal pain and ascites, weight loss and fever (37.9oC). He denied antecedents of atopy, tobacco smoking, and alcohol or drug use. Abdominal ultrasound and computed tomography studies disclosed moderate ascites, distended and inspissated small intestinal loops. Blood counts revealed leukocytosis(10,700/mm3) and eosinophilia (23%). Ascitic fluid showed high leukocyte count (1,601/mm3) and very marked eosinophilia (93%), without microorganisms, parasites or malignant cells. Laparoscopic and endoscopic evaluation with biopsy studies ruled out eosinophilic gastroenteritis and other differential diagnosis. The patient was clinically managed without use of corticosteroids, and his clinical evolution was uneventful.

A Case of Eosinophilic Gastroenteritis with Eosinophilic Ascites / 대한소화기내시경학회지

Eosinophilic gastroenteritis is an uncommon disease characterized by the presence of abnormal gastrointestinal symptoms, eosinophilic infiltration in one or more areas of the gastrointestinal tract, an absence of the indentifiable cause of eosinophilia and the exclusion of eosinophilic involvement in organs other than gut. The etiology is unknown, and the pathogenesis is poorly understood. Clinical presentations depend on the region of gastrointestinal tract involved and the depth of bowel involvement. We experienced a case of eosinophilic gastroenteritis involving entire GI tract with eosinophilic ascites in a 72-year-old female with abdominal distention and pain. The patient was treated with corticosteroid successfully. We report this case with a brief review of the literatures.

Eosinophilic Gastroenteritis Involving Entire Gastrointestinal Tract with Eosinophilic Ascites / 대한소화기내시경학회지

Eosinophilic gastroenteritis is a rare disease of unknown cause characterized by eosinophilic infiltration in various areas of gastrointestinal tract with gastrointestinal symptoms such as abdominal pain, vomiting, diarrhea and rarely ascites. Its clinical feature depends on the type of layer and location involved. Serosal eosinophilic infiltration, the rarest form of presentation, may result in development of eosinophilic ascites. We experienced a case of eosinophilic gastroenteritis involving entire gastrointestinal tract with eosinophilic peritoneal fluid in a 38-year-old female with abdominal distension and abdominal pain. Upper gastrointestinal endoscopy, colonoscopy, small bowel series, abdominal CT showed diffuse wall thickening from esophagus to rectum. The eosinophilic peritoneal fluid and peripheral eosinophilia were confirmed by multiple biopsies of the gastrointestinal tract. She was treated with corticosteroid and responded dramatically. We report this case with a brief review of the literatures.

A case of Eosinophilic Ascites noted in Eosinophilic Gastroenteritis / 대한임상병리학회지

The observation of eosinophilic ascites is uncommon. They can be noted in parasitic disease, malignant condition, vasculitis, idiopathic hypereosinophilic syndrome or allergic disorders including eosinophilic gastroenteritis, which is a rare disease of unknown etiology characterized by massive tissue infiltration of eosinophils in the layers of any area of gastrointestinal[GI] tract. Clinical manifestations are related to the level of the histologic infiltration in the wall, and the segment of the GI tract involved. Mucosal involvement may result in abdominal pain, nausea, vomiting, diarrhea and weight loss. Muscle layer involvements have obstructive symptoms. Subserosal eosinophilic infiltration may result in the development of eosinophilic ascites. We experienced a case of eosinophilic ascites as manifestation of eosinophilic gastroenteritis in a 43-year old man who also had jejunal obstruction. High proportion of eosinophil count was noted in the ascites, however peripheral blood eosinophilia was not noted. Parasitologic studies were negative. Histologic examination of segment of jejunum showed heavy transmural infiltration of eosinophils which were extended to subserosal layer. Eosinophilic ascites noted in eosinophilic gastroenteritis, though not a common disease entity, had not been described in the laboratory medicine related papers in Korea. Therefore we report this case as an example of eosinophilic ascites.

A Case of Eosinophilic Gastroenteritis in a Child

Eosinophilic gastroenteritis is an uncommon disorder of the stomach, small bowel, and colon, characterized by eosinophilic infiltration of the gut wall and peripheral blood eosinophilia. The clinical features depend on the site of eosinophilic infiltration. Patients with eosinophilic gastroenteritis may develop an exudative ascites containing eosinophils. We experienced a case of eosinophilic gastroenteritis in a 9 year old boy who had abdominal distension, vomiting, peripheral eosinophilia, eosinophilic ascites, and marked infiltration o f eosinophils in intestinal ans subserosal layers. He received prednisone (2mg/kg/day) for 10 days. No evidence of side effect were found during the period of treatment and, at now, symptom-free state are maintained without eosinophilia or any evidence of relapse.