ABSTRACT
Eosinophilic enteritis (EoN) poses a distinctive challenge, affecting individuals with various clinical presentations depending on the layer and extent of the bowel wall. We present a case of a 19-year-old female with abdominal pain, vomiting, and loose stools for 1 month. Labs were significant for persistent leukocytosis with peripheral eosinophilia. A computed tomography of the abdomen/pelvis demonstrated moderate abdominal ascites and moderately diffuse mucosal thickening of jejunal loops. A diagnostic paracentesis unveiled low serum ascites albumin gradient and 92% eosinophils. Push enteroscopy resulted in no significant biopsy findings, though a laparoscopic full-thickness jejunal biopsy exhibited increased eosinophils in the bowel wall. Intravenous steroid, proton pump inhibitor, and dietary changes resolved the symptoms and normalized the labs within a week. Our case report highlights a variable presentation of eosinophilic jejunitis uncommon in this disease population. EoN is an easily missed diagnosis and mandates frequent follow-up to prompt relevant investigations. Atopic clinical features are not prevalent in each case. While rare, EoN requires a strong clinical suspicion, even if endoscopic biopsies are unremarkable, prompting timely laparoscopic full-thickness biopsy. Per protocol, physicians must do the infectious and eosinophilia workup to rule out other etiologies. Our case also highlights that worsening clinical condition in EoN warrants early intravenous steroids with a favorable prognosis and considers a psychosocial aspect of the disease on the patient's health.
ABSTRACT
Laparoscopic cholecystectomy is one of the most common procedures done worldwide. Post-surgical site infections are common, yet there are occurrences of uncommon complications, including port site tuberculosis (TB). We report a case of a 62-year-old man who was the victim of post-surgical site infection of port sites caused probably by improper sterilization. The patient lacked any common symptoms of tuberculosis and his initial lab investigations were not affirmative. A biopsy depicting the growth of multiple epithelioid granulomas finally led to the diagnosis of port site tuberculosis. The patient was treated by incision and drainage followed by anti-tubercular therapy. This treatment regime showed complete resolution of disease on follow-ups. Such cases require multidisciplinary team (Surgery, Pathology and Infectious disease department in our case) inputs for prompt diagnosis and treatment.
