Ascites in a Young Woman: A Rare Presentation of Eosinophilic Gastroenteritis

Abstract

Introduction Eosinophilic gastroenteritis (EGE) is a rare idiopathic disease that can affect one or more organs of the digestive tract. It has an estimated incidence of 1–20 cases per 100,000 patients. Klein et al. classified EGE into 3 subtypes: predominant mucosal, muscular, or subserosal. Clinical Case We report a case of a 32-year-old woman, who presented with diffuse abdominal pain, nausea, postprandial infarction, diarrhea, and moderate ascites of three-week evolution. The rest of physical examination did not show alterations. The past medical history was unremarkable. Laboratory test results revealed peripheral blood eosinophilia. Abdominal CT scan revealed diffuse and concentric parietal thickening of the distal 2/3 of esophagus, moderate volume ascites, and small bowel wall thickening and distension on the left quadrants. The paracentesis revealed 93.3% of eosinophils. The colon biopsies evidenced an increase in the number of eosinophils. Secondary causes of eosinophilia were excluded. The patient was treated with oral prednisolone 40 mg/day with immediate clinical and analytical improvement. Conclusion Eosinophilic gastroenteritis is a rare condition with a nonspecific and highly variable clinical presentation, which requires a high level of clinical suspicion. It is a diagnosis of exclusion. Secondary causes of eosinophilia such as intestinal tuberculosis, parasitosis, and malignant neoplasms should be excluded.

A Case of Eosinophilic Gastroenteritis Associated with Eosinophilic Ascites Diagnosed by Full-Thickness Biopsy of the Small Intestine

“…The associated allergic disorders, including asthma, allergic rhinitis, and atopic eczema are present in between 54–63% of reported cases of eosinophilic gastroenteritis [7]. Also, immunoglobulin E (IgE) levels are reported to be elevated in patients with eosinophilic gastroenteritis [5]. Elimination of antigen triggers of atopy and treatment with corticosteroids are the mainstay of patient management and lead to improvement in up to 90% of patients [2].…”

“…Elimination of antigen triggers of atopy and treatment with corticosteroids are the mainstay of patient management and lead to improvement in up to 90% of patients [2]. Second-line treatment includes mast cell stabilizers, antihistamines, and leukotriene antagonists [5].…”

“…The classification of eosinophilic gastrointestinal disease is based on the histological findings, and is based on the Klein classification, according to the predominance of eosinophils in the layers of the intestinal wall, the mucosa, muscularis propria, and serosa, and results in a wide range of clinical presentations, as summarized in Table 1 [9,10]. Compared with other subtypes, mucosal eosinophilic gastroenteritis is the most common, presenting mainly with nonspecific symptoms that include abdominal pain, nausea, diarrhea, and vomiting, and may mimic other gastrointestinal disorders [5]. More rarely, patients may present with severe with blood in the stool, iron deficiency anemia, or protein-losing enteropathy [5].…”

“…Compared with other subtypes, mucosal eosinophilic gastroenteritis is the most common, presenting mainly with nonspecific symptoms that include abdominal pain, nausea, diarrhea, and vomiting, and may mimic other gastrointestinal disorders [5]. More rarely, patients may present with severe with blood in the stool, iron deficiency anemia, or protein-losing enteropathy [5].…”

“…Other treatments for eosinophilic gastroenteritis include mast cell inhibitors, antihistamines, or leukotriene receptor antagonists [4]. Serosal eosinophilic infiltrates are present in 10% of the cases of eosinophilic gastroenteritis, and a hallmark if this subtype is peripheral eosinophilia and ascites [5].…”