Eosinophilic gastroenteritis as an unusual manifestation of multiple mesenteric lymph node enlargements and recurrent diarrheas

Abstract

Eosinophilic gastroenteritis (EG), as originally described by Kaijser in 1937, is an uncommon inflammatory disease characterized by eosinophilic infiltration of the gastrointestinal tract without evidence of known causes of eosinophilia (1). There are rare presentations of mesenteric lymph node involvement and recurrent diarrhea in Korea, and there is no agreed specific therapy for EG. Herein, we present a rare case of EG.A 58-year-old woman presented with a history of recurrent diarrhea, abdominal pain, and weight loss (5 kg in 2 weeks). Her past medical history revealed irritable bowel syndrome (IBS). She was admitted because of intractable watery diarrhea. She was treated with IBS medication (antispasmotic agent and antianxiolytics) and antidiarrheal agents. However, her symptoms had worsened. She had no family history of allergic diseases. Her physical examination was unremarkable. Laboratory tests revealed a WBC count of 8680/mm 3 and an eosinophil count of 1970/mm 3 (22.7%). The serum IgE level was 254 kU/L (normal: 0-25 kU/L). Stool examination for parasites and the allergy test were negative, including the MAST test. Endoscopic examinations revealed chronic atrophic gastritis. Abdominal pelvic CT revealed reactive changes, including above and below 1 cm-sized multiple mesenteric lymph node enlargements in the entire abdominal cavity (Figure 1). Colonoscopy revealed endoscopic features of colitis, including mucosal edema, loss of vascularity, and focal hyperemic change in the IC valve area. Multiple colonic biopsies revealed active inflammatory reactions with remarkably increased eosinophils in the lamina propria, and occasionally, the muscularis mucosa, which were consistent with EG (Figure 2). Before the use of steroids, a tricyclic antidepressant and a selective serotonin reuptake inhibitor was added to her treatment. After this, her symptoms improved and diarrhea stopped. Thus, steroid therapy was not required in this case. We administered the regimen for 4 weeks, and the patient promptly responded; the serum IgE level decreased to 99.2 kU/L. Turk

Eosinophilic colitis presenting with lower gastrointestinal bleeding: An uncommon entity with a rare presentation

“…Corticosteroids and aminosalicylates are the mainstay for initial management. Therefore, we used steroids unlike Park et al (1), and the patient's symptoms resolved.…”

“…To the Editor, We read with interest the article by Park et al (1) on eosinophilic colitis (EC) for which symptoms improved by antidepressants and anxiolytics. We present an infrequent case of EC complicated with severe lower gastrointestinal bleeding (LGIB) where the patient was treated with prednisone.…”

“…As noted by Park et al, there is no consensus on a specific therapy for EC (1,3). Corticosteroids and aminosalicylates are the mainstay for initial management.…”