Eosinophilic Gastroenteritis: An Unusual Cause of Ascites in an Adolescent Patient
Abstract
Eosinophilic gastroenteritis (EGE) is a rare disorder and eosinophilic infiltration of the gastrointestinal tract is characteristic for it. Eosinophilic ascites may seen in lymphoma, eosinophilic gastroenteritis, peritoneal dialysis, and parasitic infections too. Depending on the dominant layer of infiltration EGE is classified into three types namely, mucosal, muscularis and serosal. Rarest type is the serosal type characterized by primary serosal disease, peripheral eosinophilia and eosinophilic ascites. Here we report a case of serosal EGE. We have discussed clinical cornerstones for diagnosis and response to treatment.
A male patient age of 16 presented to the clinic with complaints of self-limiting diarrhea which stop within three weeks and abdominal distension. In physical examination tachypnea, orthopnea and marked abdominal distension were seen. Contrast-enhanced abdominal computed tomography showed the presence of ascites and diffuse thickening of small bowel wall, but did not detect a primary malignancy in the abdominal cavity; and no signs of portal hypertension or liver disease. In laboratory tests significant eosinophilia in blood and abdominal fluid were seen. Leukocyte count was 16680 /mm3 in the hemogram and 60% eosinophil was detected in the peripheral smear. In paracentesis fluid analysis; eosinophilia (70% eosinophil) were detected. Steroid treatment to be completed in six weeks in total was applied to the patient who was diagnosed with eosinophilic ascites. Therapy with corticosteroids resulted in resolution of both the gastrointestinal symptoms and the ascites without hesitation. He had not any complaint during four months follow-up; ascites regressed and examination was normal.
EGE is a rare disorder and it should be flashed in patients who presented with unexplained ascites. Since diagnosis of EGE is a diagnosis of exclusion and, apart from malignancies, there are many other secondary causes of eosinophilic intestinal infiltration that must be excluded.
Keywords
Eosinophilic gastroenteritis,ascites,corticosteroids,adolescent patient
Kaynakça
- 1. Taş A, Çelık H. An unusual cause of ascites in a young patient. Turk J Gastroenterol 2013;24(1):79-80.2. Hepburn IS, Sridhar S, Schade RR. Eosinophilic ascites, an unusual presentation of eosinophilic gastroenteritis: A case report and review. World J Gastrointest Pathophysiol 2010;1(5):166-70.3. Agrawal S, Vohra S, Rawat S, Kashyap V. Eosinophilic ascites: A diagnostic and therapeutic challenge. World J Gastrointest Surg 2016;8(9):656-659.4. Miyamoto T, Shibata T, Matsuura S, Kagesawa M, Ishizawa Y, Tamiya K. Eosinophilic gastroenteritis with ileus and ascites. Intern Med 1996;35(10):779-82.5. Caglar E, Sezgin Caglar A, Gokturk S, Dobrucali A. A Case of Eosinophilic Gastroenteritis with Ascites. Case Rep Med 2015;2015:971607. 6. Saraiva N, Filipe C, Simão A, Carvalho A. A 22-year-old male patient with ascites. BMJ Case Rep 2015;2015. 7. Sun HL, Lue KH. Eosinophilic gastroenteritis in children-report of one case. Asian Pac J Allergy Immunol 2001;19(3):221-3.8. Cuko L, Bilaj F, Bega B, Barbullushi A, Resuli B. Eosinophilic ascites, as a rare presentation of eosinophilic gastroenteritis. Hippokratia 2014;18(3):275-7.