Eosinophilic Gastroenteritis: An Unusual Cause of Ascites in an Adolescent Patient

Yıl 2019, Cilt: 14 Sayı: 3, 142 - 144, 15.11.2019

Fuat Baştürk Can Acıpayam , Mehmet Yaşar Özkars , Murat İspiroğlu Ülkü Kazancı Osman Nuri Özen Salim Ekici

https://doi.org/10.17517/ksutfd.473345

Öz

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.

Anahtar Kelimeler

Eosinophilic gastroenteritis, ascites, corticosteroids, adolescent patient

Eozinofilik Gastroenterit: Adölesan Bir Hastada Nadir Görülen Bir Assit Nedeni

Öz

Eozinofilik Gastroenterit (EGE)
gastrointestinal sistemin infiltrasyonu ile karakterize nadir bir bozukluktur.
Eozinofilik asit ise lenfoma, EGE, periton diyalizi ve paraziter
enfeksiyonlarla birliktelik gösterebilir. Serozal tip en nadir tip olup, primer
seroza hastalığı, eozinofilik asit ve periferik eozinofili ile karakterizedir.
Biz burada, tipik tanısal özellikleri ve tedavi cevabı ile birlikte bir 
serozal tip EGE vakasını sunduk.

On altı yaşında erkek hasta
kliniğe karında şişlik ve üç hafta önce başlayıp kendi kendine gerileyen ishal
şikâyeti ile başvurdu. Fizik muayenede ortopne, takipne ve belirgin abdominal
distansiyon görüldü. Laboratuvar testlerinde belirgin periferal eozinofili ve
abdominal sıvıda eozinofil sayısında artış saptandı. Hastaya toplamda altı
hafta boyunca steroid tedavisi verildi ve sonuçta gastrointestinal semptomların
ve asitin tamamen geçtiği görüldü.

Eozinofilik
gastroenterit nadir bir bozukluk olmakla birlikte açıklanamayan asit
varlığında akılda tutulmalıdır. Eozinofilik
gastroenterit, özellikle primer malinitelerde bir dışlama tanısı olmakla
birlikte, intestinal infiltrasyona sebep olan birçok sekonder neden de
bulunmakta ve tanı için bunların da dışlanması gerekmektedir.

Anahtar Kelimeler

Eozinofilik gastroenterit, asit, kortkosteroidler, adolesan hasta

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.