Eosinophilic ascites: a diagnostic challenge

Abstract

Eosinophilic ascites is a rare feature of eosinophilic gastroenteritis. We would like to highlight this increasingly recognised diagnosis in a case of unexplained ascites. We present a challenging case of a woman aged 25 years who presented with nausea, vomiting, diarrhoea, generalised abdominal pain and swelling 8-week following delivery of her first baby. Her symptoms were primarily aggravated by eating, and she had also noticed postprandial itching and self-limiting generalised rash. She had a strong history of atopy. Physical examination revealed abdominal tenderness and distension with shifting dullness. Urticarial skin rash was noted on the face, neck, chest and abdomen. Routine biochemistry was normal apart from peripheral eosinophilia. Imaging confirmed moderate ascites. Diagnostic paracentesis showed exudative ascites with numerous eosinophils. Histology of the upper and lower gastrointestinal tract showed infiltration of the oesophageogastroduodenal and rectosigmoid mucosa with eosinophils. The patient significantly improved following a course of steroids and six-food elimination diet.

Causes of eosinophilic ascites – A systematic review

“…EA-EGE was also described in patients with autoimmune diseases: scleroderma, SLE, polymyositis, dermatomyositis [57,65] and celiac disease [15,62]. EA in postpartum females, mainly associated with EGE, was also reported in three cases [28,34,73].…”

“…In addition to the symptoms described above, 29 subjects associated less frequent features like constipation (6) [13,[22][23][24][25][26], bloating (1) [27], skin rash (4) [27][28][29][30], fever (3) [31][32][33], edema (2) [34][35], malabsorption (1) [36], melena (1) [37], even signs of pyloric stenosis (3) [38][39][40], intestinal occlusion or subocclusion(6) [41][42][43][44][45][46], peritonitis secondary to appendicitis (1) [47] and DVT in one patient with acute pancreatitis [48].…”

“…In some cases peritoneal nodules (1/22) [33], liver involvement (2/22) [31,70], eosinophilic dermatitis (1/22) and fasciitis (1/22) [71][72] were described. EA-EGE also affected women in the post-partum period at 8 and 10 weeks postpartum [28,34,73].…”

“…In addition to CS, dietary measures were recommended in 5 patients [6,19,24,28,75]. CS along with treatments for allergies: Montelukast (2) [7,66], sodium chromoglycate (1) [27], cetirizine (1) [76] and loratadine (1) [42] were also successfully used.…”

Eosinophilic peritonitis and nephrotic syndrome in Kimura’s disease: a case report and literature review

“…Eosinophilic peritonitis is a relatively rare entity. The etiology of eosinophilic peritonitis is multifactorial, mostly being reported in patients with eosinophilic gastroenteritis, parasitic and fungal infections, hypereosinophilic syndrome and less common diseases including malignancy, hematological disorders, inflammatory bowel disease, autoimmune disease and peritoneal dialysis [1][2][3]. Kimura's disease is a rare chronic inflammatory disorder of unknown etiology, characterized by subcutaneous nodules mainly in the head and neck region, regional lymphadenopathy and occasional involvement of the major salivary glands and kidney.…”