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).

Efficacy of endoscopic biopsies in the differention between different types of colitis. [a retrospective and prospective study]

This study was undertaken on 80 cases of colitis and 5 control cases. The study subjects were subdivided into 2 groups [GI] included 50 consecutive patients from Division of Gastroenterology, Department of Medicine. They were subjected to detailed history taking, thorough clinical examination, stool analysis, colonoscopy and biopsy. [GII] included 30 retrospective cases collected from the files of Pathology department. All specimens were subjected to routine histopathological examination. They were classified into Schistosomal colitis [26 cases -32.5%], amaebic colitis [16 cases - 20%], acute self limited colitis [ASLC] [3 cases - 3.75%], Crohn's disease [CD] [11 cases - 13.75%], chronic ulcerative colitis [CUC] [14 cases - 17.5%], collagenous colitis [one case - 1.25%] and colitis with non-specific pathologic changes [9 cases - 11.25%]. For CD, skip lesions and cobblestones were the main diagnostic endoscopic findings which were detected in 5 cases only, while the diffuse wet glaring mucosa from blood, mucus were the main findings in UC and ASLC. Microscopically, maintenance of glands architecture with persevered goblet cell population despite heavy deposition of the lamina propria by inflammatory cells mainly histiocytes that extended into the submucosa were the main diagnostic points of CD. While glands destruction and atrophy associated with cryptitis and inflammatory infiltrates mainly plasma cells were the main features of CUC. In cases of ASLC, history of acute colitis associated with preserved gland architecture, edema and inflammatory infiltrate mainly PNL that localized predominantly in the lower half of the mucosa were the main features. For collagenous colitis, chronic watery diarrhea with microscopic detection of subepithelial layer of collagen were the diagnostic signs. Accordingly we could conclude that proper diagnosis of colitis and subsequently proper management could be reached in almost every case with colitis but it rests on clinical, endoscopic, and pathological correlation provided that full colonoscopic examination was undertaken and sufficient number of biopsies of full thickness mucosa and at least part of the submucosa were taken from the proper sites