Eosinophilic Enteritis: A Delayed Diagnosis

Abstract

Eosinophilic gastrointestinal disorders are a rare and complex group of disorders that are characterized by eosinophilic infiltration of the gastrointestinal tract. Patients often present with a wide range of signs and symptoms as any length or layer of the GI tract can be involved such as mucosal, muscular, or serosal. As a part of the workup, patients frequently undergo computed tomography scans and multiple endoscopies before the diagnosis is finally made as was true in our case of a 59-year-old male patient presenting with 2 months of nausea, abdominal pain, and weight loss. He underwent esophagogastroduodenoscopies, colonoscopies, video capsule study, and balloon enteroscopy before the diagnosis was confirmed histologically. Endoscopic and radiographic findings can be variable and are usually unpredictable. The diagnosis is confirmed on histopathological examination of biopsies that must show >15-50 eosinophils/high-power field based on the location in the GI tract. In our patient, erythema, scalloping, whitish exudate, and patches of villous blunting were noted in the duodenum to proximal ileum endoscopically with >50 eosinophils/high-power field confirming the diagnosis of eosinophilic enteritis. This class of diseases is often found in patients with a history of allergic disorders suggestive of hypersensitivity in the etiology of the disease although our patient had no such known history. Elimination diets and steroids are the mainstay of therapy and often lead to complete resolution of symptoms as well as endoscopic and radiographic findings in up to 90% of patients as was seen in our patient, although some patients have a chronic remitting course.

Gastric outlet obstruction as manifestation of eosinophilic gastroenteritis

“…The clinical manifestations are chronic abdominal pain, vomiting and diarrhea, to weight loss and obstruction, in some cases, even chest pain has been observed as a symptom. Usually, when the muscular layer is compromised, obstructive manifestations, as seen in our patient (8,9) . Histopathology findings the presence of eosinophils in the muscularis mucosae is almost always considered abnormal (10) .…”

A case report about eosinophilic enteritis presenting as abdominal pain

“…[ 17 ] Patients diagnosed with EE often have a history of allergic disorders including asthma, eczema, seasonal allergies, and food allergies. This suggests hypersensitivity as the etiology of the disease, [ 11 ] which may activate and promote the differentiation of interleukin (IL)-5 via Th2 cells, resulting in eosinophilic infiltration of the gut. [ 18 ] However, food intolerance or a history of allergies is not usually present and IgE levels are less frequent.…”

Lymphoplasmacytic and eosinophilic enteritis with or without globule leukocyte hyperplasia in 4 goats

“…The mucosal and submucosal layers can be affected along any part of the gastrointestinal tract. 1,2 Inflammatory bowel diseases with eosinophilic infiltrates can be idiopathic or secondary to parasitism, drug reaction, systemic eosinophilic syndrome, or malignancy in ruminants and other species. [3][4][5] In cases without an identified underlying cause, immunosuppressive therapy with corticosteroids is often pursued.…”

“…Lymphoplasmacytic and eosinophilic enteritis is characterized by intestinal infiltration with lymphocytes, plasma cells, and eosinophils. The mucosal and submucosal layers can be affected along any part of the gastrointestinal tract 1,2 . Inflammatory bowel diseases with eosinophilic infiltrates can be idiopathic or secondary to parasitism, drug reaction, systemic eosinophilic syndrome, or malignancy in ruminants and other species 3‐5 .…”