Enteritis eosinofílica. Presentación de un caso y revisión de la literatura / Eosinophilic enteritis. Case presentation and literature review

RESUMEN La enteritis eosinofílica consiste en la presencia de infiltrados eosinofílicos en el tracto digestivo. Constituye en la actualidad una entidad rara que puede localizarse en cualquier región del tubo digestivo. Su etiopatogenia se desconoce y en muchas ocasiones se relaciona con antecedentes de atopia. Las manifestaciones clínicas varían en función de las capas afectadas. Se presentó el caso de un paciente de 26 años de edad, con antecedentes de haber sido operado de apendicitis aguda, en el año 2011. Llegó al Cuerpo de Guardia refiriendo dolor intenso, fijo; en fosa iliaca derecha, acompañado de fiebre de 39°C, con escalofríos y síntomas dispéptico. Se orientó ingreso y se le realizó una videoendoscopia, se observó gastritis antral eritematosa exudativa con test para Helicobacter pylori positivo. Además, una videolaparoscopia arrojando presencia de asas delgadas apelotonadas y adherencias no recientes en fosa iliaca derecha. A pesar del tratamiento empleado el paciente continuó con dolor y fiebre, por lo que se decidió indicarle una enteroscopia de doble balón con biopsia de íleon. Se informó que a nivel del colon presentaba una colitis crónica inespecífica y en el íleon una hiperplasia linfoide. El estudio histopatológico confirmó la colitis inespecífica y una eosinofilia moderada en íleon. Se indicó tratamiento con prednisona y mesalazina con mejoría notable del cuadro clínico, fue dado de alta con el diagnóstico de una enteritis eosinofílica, con seguimiento por consulta externa de gastroenterología. En la actualidad se mantiene asintomático (AU).

ABSTRACT Eosinophilic enteritis is the presence of eosinophilic infiltrates in the digestive tract. Currently it is a rare entity than could be located in any region of the digestive tract. Its etiopathogenesis is unknown and is related, in many cases, to antecedents of atopy, Clinical manifestations may vary according to the affected layer. The authors present the case of a patient aged 26 years, with antecedents of having undergone an acute appendicitis surgery in 2011. He arrived to Emergency referring intense, steady pain in the right iliac fossa, accompanied by a 39o C fever, chills and dyspeptic symptoms. He was admitted and a video endoscopy was carried out. An exudative erythematous antral gastritis was observed with a positive test for Helicobacter pylori. In addition, video laparoscopy also showed the presence of thin, lumped loops and no-recent adherences in the right iliac fossa. In spite of the applied treatment, the patient continued with pain and fever, so the doctors indicated a double-balloon enteroscopy with ileum biopsy. It was informed an unspecific chronic colitis at the colon level and a lymphoid hyperplasia in the ileum. The histopathologic study confirmed the unspecific colitis and a moderate eosinophilia in the ileum. A prednisone and mesalazine treatment was indicated with a notable improvement of the clinical characteristics. The patient was discharged diagnosed with a eosinophilic enteritis and follow-up in out-patient consultation of Gastroenterology. Currently he keeps on asymptomatic (AU).

Colitis eosinofílica como causa de diarrea crónica / Eosinophilic colitis as a cause of chronic diarrhea

Resumen La colitis eosinofílica es una enfermedad rara e idiopática caracterizada por la infiltración eosinofílica del colon y que hace parte del espectro de la gastroenteritis eosinofílica. Esta entidad tiene síntomas inespecíficos y en la actualidad no hay estudios clínicos, por lo cual la evidencia científica se basa en series de casos o reportes aislados. Esta patología requiere de un enfoque diagnóstico adecuado para descartar otras causas de eosinofilia en el colon, para poder así ofrecer un manejo farmacológico y no farmacológico dirigido y especializado para lograr la remisión de la enfermedad, por lo cual para ofrecer una atención oportuna, se debe tener en cuenta dentro del diagnóstico diferencial de aquellos pacientes jóvenes con diarrea crónica para lograr mejorar el enfoque diagnóstico y promover la realización de estudios clínicos que mejoren la calidad de la evidencia científica actual. Presentamos el primer caso con compromiso exclusivo del colon reportado en Colombia de una mujer con antecedente de enfermedades atópicas. (Acta Med Colom 2019; 44: 47-50)

Abstract Eosinophilic colitis is a rare and idiopathic disease characterized by eosinophilic infiltration of the colon and is part of the spectrum of eosinophilic gastroenteritis. This entity has nonspecific symptoms and currently there are no clinical studies, so the scientific evidence is based on case series or isolated reports. This pathology requires an adequate diagnostic approach to rule out other causes of eosinophilia in the colon, in order to offer a directed and specialized pharmacological and non-pharmacological management to achieve remission of the disease, so that to offer timely care it should be considered in the differential diagnosis of those young patients with chronic diarrhea in order to improve the diagnostic approach and promote performance of clinical studies that improve the quality of current scientific evidence. This is the first case with exclusive involvement of the colon reported in Colombia of a woman with a history of atopic diseases. (Acta Med Colom 2019; 44: 47-50)

Housedustmite Allergy as the Cause of Eosinophilic Collitis: A Case Report

@#There are only few cases of Eosinophilic Collitis(EC) have been reported worldwide. The mechanism and aetiology of EC are still unclear. We describe a 35 years old man presented with chief complaints of gastrointestinal symptoms. In blood examination, his total IgE and specific IgE to house dust mites were very high. Colonoscopy was done and histological examination from biopsy specimens reported infiltration of lymphoplasmacytic cells and eosinophils, compatible with Eosinophilic colitis. The patient was treated with antihistamine and short course of antibiotics. He was been advised to avoid house dust mites. He was then remained asymptomatic. Our report suggests house dust mites allergy as the causes of EC. Combination of antihistamine, antibiotics and avoidance of house dust mites are helpful in treating EC in this particular case.

A Case of Steroid Treated Amebic Colitis Misdiagnosed as Eosinophilic Colitis / 대한소화기내시경학회지

Some cases have reported that amebic colitis leads to serious complications that are caused by a misdiagnosis of an inflammatory bowel disease and consequential ill-managed steroid therapy. Therefore, it should be stressed that the differential diagnosis on such a case is very important. Eosinophilic colitis may reveal its presence as diarrhea, abdominal pain, ascites, and eosinophilic deposits in tissues. Therefore, it is highly necessary to make a differential diagnosis to distinguish eosinophilic colitis from other infectious or inflammatory bowel diseases. We report a case of amebic colitis, which was mistakenly diagnosed as eosinophilic colitis and a liver eosinophilic abscess in a young male who complained of bloody diarrhea and right upper quadrant pain. However, the misdiagnosed steroid therapy did not aggravate the progress of the amebic infection.

Eosinophilic Colitis Presenting with Bloody Diarrhea: Case Report / 대한소화기내시경학회지

Eosinophilic colitis is a chronic inflammatory bowel condition of unknown etiology and a rare subtype of eosinophilic gastrointestinal diseases. It is characterized by gastrointestinal symptoms and increased eosinophil numbers in the intestinal mucosa and absence of other potential causes of gastrointestinal eosinophilia. The clinical presentation is varied and depends on the involved layer of the large intestine. There are no confirmatory laboratory tests, and the morphologic evaluation of biopsies or surgical specimens is required to confirm the diagnosis. A 65-year-old man presented with an 8 day duration of bloody diarrhea and lower abdominal pain. The patient was diagnosed with eosinophilic colitis by histopathological evaluation of biopsies and was further categorized as a nonatopic variant associated with non-IgE-mediated reaction. The patient was successfully treated with systemic corticosteroid for 2 weeks. On follow-up after 9 months, the patient remained well without relapse or new lesions.

Clinical Features of Eosinophilic Colitis Developed in Early Infancy / 대한소아소화기영양학회지

PURPOSE: Eosinophilic colitis is a disease characterized by gastrointestinal symptoms, peripheral eosinophilia, eosinophilic infiltration of the colonic wall. The etiology and pathogenesis of this disease is not clear and it is considered to be idiopathic. This study aimed to ascertain the clinical features, treatment and prognosis of eosinophilic colitis in early infancy. METHODS: We reviewed 6 infants retrospectively, presented with bloody stool in early infancy, who were diagnosed with eosinophilic colitis in Pusan National University Hospital between August 2002 and February 2004. RESULTS: Five males and one female were included. The mean age when bloody stool was identified was 79.2+/-56.1 days (10~145 days). All but one infant with atopic dermatitis did not have other allergic diseases. Nobody had a family history of allergic disease. No specific dietary history in infants and their mothers related to food allergy was identified. Peripheral eosinophilia (total WBC count 11,763+/-3,498/mm3, eosinophils 17.0+/-4.3%, absolute eosinophil count 2,044+/-996/mm3) was observed in all infants. Colonoscopy in six infants revealed diffuse erythema, congestion and granulation pattern of mucosa in the rectosigmoid colon. Histopathologic findings of colononic biopsies showed chronic inflammation with severe eosinophilic infiltration in the mucosa. Two infants were treated with hydrolyzed casein-based formula and four infants with prednisolone. Gastrointestinal symptoms and peripheral eosinophilia resolved completely with prednisolone and partially with a hydrolyzed casein-based formula. Relapse was not observed during the follow-up period. CONCLUSION: Our study demonstrated that there is no evidence of a definite relationship between eosinophilic colitis and food-allergic disorders. Clinical course and prognosis of infantile form of eosinophilic colitis is very favorable and treatment with prednisone was effective.

Successful Cyclophosphamide Therapy in Recurrent Eosinophilic Colitis Associated with Hypereosinophilic Syndrome

Eosinophilic colitis is a relatively rare complication of hypereosinophilic syndrome which is characterized by abdominal pain and bloody diarrhea and is usually treated with steroids and hydroxyurea. However, no standard regimen exists in cases of intractable disease despite several treatment attempts with Interferon- alpha, cyclosporin, etoposide, and vincristine, etc. We here report a case of a 43-year-old woman with recurrent eosinophilic colitis as a complication of hypereosinophilic syndrome who was successfully treated with cyclophosphamide.

A Clinical and Histological Study of Allergic Colitis in Infant

PURPOSE: This study was done to evaluate the clinical and pathologic aspects of allergic colitis. METHODS: This study evaluated 19 infants who presented with fresh blood mixed stools. Limited colonoscopy and biopsy were performed. Among the 19 infants, 13 infants were diagnosed as allergic colitis by histological findings. We analyzed the clinical and histological characteristics of 13 infants. RESULTS: Male and female were 8 and 5 respectively. The mean age of the infants was 3 months (4 days to 12 months). Major symptoms were rectal bleeding (13), mucoid stool (6), diarrhea (5), vomiting (2). Feedings before diagnosis were breast milk (3), formula milk (4), formula and breast milk (5), and weaning diet (1). In labortory data, anemia (2) and eosinophilia (12) were found in some infants. Endoscopic findings were focal erythema (7), nodularity (1), erythema and nodularity (4), hemorrhage (1). Histopathologic finding was eosinophilic infiltration in lamina propria with preserved mucosal architecture in all. In addition, cryptitis (13), lymphoid follicular hyperplasia (7), crypt abscess (1) were also observed. All the infants improved with cessation of rectal bleeding and diarrhea within three days after dietary change. CONCLUSION: Allergic colitis should be considered as one of the major cause of rectal bleeding in healthy appearing infants. Limited colonoscopy and biopsy should be considered in establishing a definitive diagnosis.

A Case of Eosinophilic Colitis as a Complication of the Hypereosinophilic Syndrome / 대한소화기내시경학회지

The hypereosinophilic syndrome (HES) is a leukoproliferative disorder, marked by a sustained overproduction of eosinophils and a predilection to damage specific organs. There are several diagnostic criteria. First, the patient must sustained blood eosinophilia of greater than 1,500/mm3, for longer than 6 months. Secondly, other apparent etiologies for eosinophilia must be absent, ineluding parasitic infections and allergic diseases. Thirdly, the patient must have signs and symptoms of organ involvement. Cardiac and neurologic diseases, frequent in HES, are major causes of morbidity and mortality. The damage to the heart and nervous system is due to thrombosis and fibrosis. Gastrointestinal tract involvement can accompany HES, but severe eosinophilic colitis was very rarely described in association with this syndrome. In this report, we present a patient with HES and eosinophilic colitis who was successfully treated with steroids.