Eosinophilic enteritis observed during alpha-interferon therapy for chronic hepatitis C

Abstract

We report a patient with chronic hepatitis C who developed eosinophilic enteritis while being treated with recombinant interferon alpha-2b. He had no history of either allergic disorders or recurring episodes of abdominal cramps, nausea, or diarrhea. He also had had a normal eosinophil count prior to the interferon treatment. After a 12-week course of interferon alpha-2b, he began to complain of severe abdominal pain, diarrhea, and abdominal fullness. His peripheral eosinophil count increased to 45% (absolute count, of 7,610/microl). Abdominal ultrasonography and computed tomography revealed diffuse thickness of the intestinal wall with gross ascites that contained numerous eosinophils. An upper gastrointestinal barium study with small bowel follow-through showed an edematous mucosal layer of the jejunum and ileum. There was a spectacular relief of the patient's subjective symptoms after the administration of prednisolone. Follow-up studies revealed resolution of the ascites and the mucosal layer edema and normalization of the peripheral eosinophil count. Prednisolone was tapered off, but the eosinophilic enteritis did not recur. As there had been no evident exposure to common causative factors for eosinophilic enteritis, we suggest that interferon alpha-2b could thus have played a role in the triggering of the eosinophilic enteritis.

Causes of eosinophilic ascites – A systematic review

“…Two patients with CT scans describing peritoneal involvement [18,56] and another one with gastrointestinal wall thickening [37], underwent surgery and peritoneal fragments from all 3 subjects were sent for histological analysis. In 10 out of 19 cases with endoscopic lesions (1) [34], peritoneal involvement (1) [15], gastrointestinal wall thickening (3) [49,[57][58], endoscopic lesions with gastrointestinal wall thickening (1) [59], as well as in peritoneal involvement and gastrointestinal wall thickening association (1) [ [63][64]. Associations between EGE and autoimmune diseases were described in 3 patients: one with systemic lupus erythematosus [65], one with lupusscleroderma overlap syndrome and heterozygous bthalassemia [57], and another one presenting positive antinuclear antibodies [50].…”

Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review

“…Some of these medications include carbamazepine [96], gold compounds [97], rifampicin [98], naproxen and other non-steroidal anti-inflammatory drugs [99,100], interferon [101], azathioprine [102], gemfibrozil [103], clofazimine [104], and enalapril [105]. Saeed et al reported three cases of EC in liver transplant recipients, maintained on tacrolimus [106].…”

Obscure gastrointestinal bleeding as first symptom of eosinophilic jejunitis in a liver transplant recipient: diagnosis and treatment with single balloon enteroscopy

“…It may be of significance that our patient received interferon α treatment because of recurrent post-transplant hepatitis C before the development of symptoms, later attributed to eosinophilic enteritis. Notably, eosinophilic enteritis has been already reported only in a single non–transplanted patient receiving interferon α therapy for hepatitis C,10 which suggests, however, that interferon induced immune stimulation may be capable of triggering an eosinophilic reaction. This matter is further complicated in liver transplant recipients by the need for maintenance immunosuppression to control cellular rejection.…”