Case Report of Eosinophilic Gastroenteropathy and a Literature Review

Abstract

Introduction: Eosinophilic gastroenteropathy is a rare disease characterized by infiltration of eosinophils into one or more layers in different parts of the gastrointestinal tract especially the stomach and the duodenum. Although in most cases it presents with abdominal pain, vomiting, diarrhea, ascites and weight loss may also appear.

Case report: The patient was a 41 year old man with a clinical picture of 9 months of sudden, intermittent abdominal pain (predominantly mesogastric pain which radiated to the lumbar region). He had been treated with antispasmodics but had not improved. Eleven years earlier he had had a right nephrectomy because of hydronephrosis.  Three years earlier he had been diagnosed and treated for hypochromic microcytic anemia with hypereosinophilia. Two years earlier he had had an acute myocardial infarct, although angiography showed healthy coronary arteries.  Seven months earlier he developed acute appendicitis. The pathology report at that time showed eosinophilic infiltrates, and a bone marrow biopsy revealed eosinophilia. Physical examination showed normal vital signs, but his bowel sounds were more intense and frequent (40/min) than normal, and he suffered mesogastric pain on palpation. There were no masses or organomegaly. Laboratory tests revealed anemia and 16% eosinophilia. Diagnostic images showed esophageal and gastric ileitis with microscopic evidence of eosinophil infiltration in all samples. Eosinophilic gastroenteropathy was diagnosed, and the patient was started on a hypoallergenic diet and treated with prednisone. Up to 25% of patients with hypereosinophilic syndrome may have gastrointestinal infiltration. Eosinophilic gastroenteropathy should be suspected in any patient with abdominal pain and peripheral eosinophilia. However, peripheral eosinophilia is not always present, and histopathological diagnosis is necessary.