Eosinophilic ascites with marked peripheral eosinophilia

Abstract

Eosinophilic disease of the gastrointestinal tract is rare and is characterized by the presence of gastrointestinal symptoms in association with eosinophilic infiltration of any part of the gastrointestinal tract. Clinical presentation of eosinophilic gastroenteritis (EGE) varies not only by the part of the gastrointestinal tract involved but also with the depth of eosinophilic infiltration of the gut wall. We describe the case of a 41-year-old woman with a history of atopy who presented with severe abdominal pain and diarrhoea. Investigations showed large-volume eosinophil-rich ascites and a markedly elevated peripheral blood eosinophil count and immunoglobulin E level. Bone marrow aspirate, trephine biopsy and T-cell studies showed no evidence of underlying haematological malignancy. Vasculitic disease and parasitic infection were systematically excluded. Colonic and upper gastrointestinal biopsies confirmed a diagnosis of EGE with eosinophilic ascites. The patient was treated with systemic corticosteroids and dietary allergen elimination with dramatic therapeutic response. The diagnostic and therapeutic challenges associated with EGE in its various forms are discussed.

Eosinophilic effusions: A clinicocytologic study of 12 cases

“…The significant presence of lymphocytosis in eosinophilic fluids may suggest a role played by T‐helper lymphocytes and their interleukins in inducing eosinophilia. In eosinophilic ascites, the possibility of eosinophilic gastroenteritis should be clinically considered . In eosinophilic peritonitis which could be associated with subserosal‐type eosinophilic gastroenteritis, the mucosal biopsy of the gastrointestinal tract may not show specific diagnostic features .…”

“…The clinical importance of a correct cytologic recognition of EEs is that in many cases EEs may point to a specific benign treatable medical condition. [13][14][15] The cause of EPEs is not identified in 14%-35% of the reported cases. [2][3][4][5][6][7][8][9][10][11][12] These were referred to as idiopathic EEs.…”

“…In eosinophilic ascites, the possibility of eosinophilic gastroenteritis should be clinically considered. 13,14 In eosinophilic This study was limited by the absence of follow-up data for seven patients. This precluded the opportunity to perform additional diagnostic laboratory tests and confirmatory histology specimens which might have helped to further investigate for possible underlying causes and associated clinical conditions.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12] Few studies, mostly case reports, described eosinophilic ascites and rarely eosinophilic pericardial effusions. [13][14][15] The aim of this retrospective study was to study the prevalence of EEs in all body cavities, to identify certain cytomorphologic patterns and potential diagnostic pitfalls and clues, to find a correlation between fluid eosinophils and blood eosinophils and any associated causative medical conditions.…”

“…D, An example of mononuclear and binucleated giant cell-like macrophages with engulfed cannibalized-like eosinophils and engulfed asteroid-like crystals (conventional smear, Papanicolaou, ×1000) [Colour figure can be viewed at wileyonlinelibrary.com] peritonitis which could be associated with subserosal-type eosinophilic gastroenteritis, the mucosal biopsy of the gastrointestinal tract may not show specific diagnostic features 13. The clue is a history of atopy, raised peripheral eosinophils, an elevated IgE, and a radiologic evidence of thickening and rigidity of the bowel wall associated with eosinophilic ascites in which other etiologies are excluded 13,14. Eosinophilic pericardial effusions may indicate a life-threatening complication of eosinophilic pericarditis secondary to eosinophilic myocarditis due to hypereosinophilic syndrome 15.…”