Eosinophilic Enteritis: Presenting as Acute Abdomen

Background: Eosinophilic gastrointestinal diseases (EGIDs) are immune-related disorders, that present with GI symptoms and on biopsy as eosinophil-predominant inflammation, where there is no secondary cause of eosinophilia.^1,2

Introduction: We report a case, where patient with EE presented with severe pain abdomen and loose stools, highlighting the diagnostic dilemmas that these disorders present with.

Case: A 35-year-old male patient presented with h/o severe pain abdomen for last 15 days; pain was associated with intermittent episodes of vomiting and loose stools.

He was admitted elsewhere previously, wherein, USG abdomen, CECT abdomen, MRI abdomen were done and all were normal.

He was admitted and evaluated, further blood tests and upper and lower GI endoscopy were done; blood tests revealed high eosinophil counts: 2,200; Stools had no ova/cysts; occult blood positive; IGA TTG: negative; CRP was 10: stool calprotectin: 179; serum IGA and IGG levels were normal; pANCA and cANCA: negative; LDH normal; ESR 56.

IGE: 975; patient had raised S creatinine initially (prerenal/NSAID induced), which improved in due course of time. Colonoscopy ([Fig. 1]) revealed multiple ileal nodules: biopsy was taken; However, colonic, mucosa appeared normal; HPE revealed ([Fig. 2]): ileal tissue with diffuse eosinophilic infiltrate (>50/hpf) involving mucosa and submucosa with focal intra epithelial eosinophils. Crypt and villous architecture is maintained. Patient was started on Tab Prednisolone 40 mg daily; his pain improved, loose stools settled; patient was discharged; on follow-up: his pain had subsided completely; blood eosinophil count normalized.

Discussion: Eosinophilic enteritis: Kaijser, 1937 is defined by the presence of GI symptoms associated with eosinophil infiltration of intestinal mucosa, without secondary eosinophilia³ The exact pathogenesis is not clear; high absolute eosinophil count and elevated serum IgE levels favor an allergic origin of EE; parasitic infections, bacterial infections, and allergens contribute to the activation of eosinophils in the GI wall. eosinophils release acidotic cationic proteins (major basic protein, eosinophil cationic protein, eosinophil peroxidase, and eosinophil-derived neurotoxin) and pro-inflammatory cytokines (interleukin-4, interleukin-5, interleukin-13, and RANTES)⁴

Conclusion: Our case presents a unique manifestation of EE: severe pain abdomen; it is important for clinicians to consider this entity, when other causes are ruled out.

Fig. 1

Fig. 2

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Artikel online veröffentlicht:
22. April 2024