A case of eosinophilic gastroenteritis with high PET-CT accumulation treated by P-CAB

Abstract

Eosinophilic gastroenteritis (EGE) can present findings on computed tomography (CT) images that resemble malignant tumors. EGE is generally treated with systemic oral steroid administration, which is reportedly effective in relieving symptoms at least temporarily. Here, we report a case of EGE that mimicked malignant lymphoma in a gastroduodenal lesion, in which treatment with a potassium-competitive acid blocker without systemic oral steroid administration relieved the symptoms and reversed the initial image findings. A 56-year-old woman became aware of discomfort in her epigastric region, which gradually worsened. This case showed antroduodenal wall thickness, which mimicked a malignant lymphoma with increased F-18 fluorodeoxyglucose (FDG) uptake by positron emission tomography/computed tomography (PET/CT). An upper gastrointestinal endoscopy revealed protruding erosions in the antrum and severe edematous changes in the duodenum. Extensibility of the normal gastric wall by insufflation also occurred. However, an abdominal ultrasound indicated wall thickening with a preserved wall structure. Histological examinations showed a large amount of eosinophil infiltration, mainly in the gastroduodenal mucosa, without malignant cells. Thus, we made a final diagnosis of EGE. The patient was then administered 20 mg vonoprazan fumarate per day because she refused steroid treatment and because the pathological lesion was also localized from the duodenum to the antrum. After 3 weeks of potassium-competitive acid blocker treatment, her symptoms were alleviated, and the degree and extent of thickening of the gastroduodenal wall in upper gastrointestinal endoscopy and ultrasonographic image findings had remarkably improved.

Pseudotumor of the stomach caused by hypereosinophilic syndromes: A case report and literature review

“…Subsequently, in combination with the histopathology of further EUS-guided FNA, history of present illness and laboratory examination, and importantly, a favorable response to steroid therapy, we nally diagnosed that this patient had the HES prominently involving the stomach. Herein, we searched previous literatures around the situation of eosinophilic in ltration-simulated tumors, and found that they have once been misdiagnosed or suspected as lymphoma in distal stomach and duodenum, colon cancer with hepatic metastases, pancreatic tumor, and late-stage gastric carcinoma [10][11][12][13][14]. We summarized the characteristics of these cases involving digestive system in the Table 1.…”