An Atypical Case of Eosinophilic Gastroenteritis Presenting as Hypovolemic Shock

Abstract

Eosinophilic gastroenteritis is an uncommon condition characterized by focal or diffuse infiltration of eosinophils in the gastrointestinal tract in the absence of secondary causes. The pathogenesis of this condition is not well understood and its clinical presentation depends on the segment and layer of the gastrointestinal tract affected. The definition of eosinophilic gastroenteritis may be difficult, as the normal ranges of eosinophil numbers in normal and abnormal gastric and intestinal mucosa are not standardized. We present the case of a 59-year-old male who came to the hospital with hypovolemic shock and lethargy secondary to severe diarrhea. Laboratory analysis was significant for peripheral eosinophilia, and pathology from both the duodenum and colon showed marked eosinophilic infiltration.

Eosinophilic gastroenteritis: Atypical cause for chronic diarrhea in human immunodeficiency virus-associated immunosuppression

“…Primary eosinophilic gastrointestinal disorders are disorders of the gastrointestinal tract that include eosinophilic esophagitis, eosinophilic gastritis, EGE, eosinophilic enteritis, and eosinophilic colitis, characterized by eosinophilic-rich inflammation in the absence of any known causes of eosinophilia. [1] Eosinophils are present in the mucosal, muscular, or subserosal layers in excess of 20 per high-power field[2] and more commonly involve the stomach and duodenum[3] as seen in our patient. Although serum eosinophil counts are frequently elevated, up to 20% of patients have been reported to have normal counts.…”

“…Although serum eosinophil counts are frequently elevated, up to 20% of patients have been reported to have normal counts. [2] Large-scale population studies in the US have estimated the prevalence of EGE to be 28/100,000 persons. [4] Eosinophilic gastrointestinal disorders affect all ethnic groups between 20 and 50 years of age but more commonly around the third decade of life.…”

“…In our patient, diarrhea persisted even after stopping antituberculosis therapy, thus ruling out secondary causes of EGE. [2] Primary EGE has not been reported before in HIV-associated immunosuppression and should be kept as a differential diagnosis in patients with HIV presenting with chronic diarrhea.…”

March of the Eosinophils: A Case of Eosinophilic Gastroenteritis, Immune Thrombocytopenia, and Iron Deficiency Anemia

“…While there is no consensus value for how many eosinophils per HPF are required to diagnose EGE, pathologists such as Dr. Collins at Cincinnati Children’s Hospital recommend using 30/HPF when evaluating the duodenum and 30/HPF in five samples when evaluating the stomach [ 10 ]. Others, such as Gaballa et al, use a cutoff of 20 eosinophils/HPF to diagnose EGE [ 1 , 6 , 8 , 11 , 12 ].…”

“…The mainstay pharmacotherapy for EGE presently is glucocorticoids [ 1 , 7 , 11 ]. Rached and Hajj recommend initiation of prednisone as the first-line choice for EGE as their literature review has revealed remission rates ranging anywhere between 50-90% [ 1 ].…”