1
|
El Ray A, Montasser A, El Ghannam M, El Ray S, Valla D. Eosinophilic ascites as an uncommon presentation of eosinophilic gastroenteritis: A case report. Arab J Gastroenterol 2021; 22:184-186. [PMID: 34090834 DOI: 10.1016/j.ajg.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/26/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Eosinophilic gastroenteritis (EGE) is defined by the presence of gastrointestinal symptoms, with an abnormal eosinophilic infiltrate of the intestine wall and exclusion of other causes of secondary eosinophilia. EGE has three clinical presentations, depending on the depth of eosinophilic infiltration of the bowel wall. It individualizes into three types, namely mucosal, muscular, and subserosal. Eosinophilic ascites, which is caused by edema and eosinophilic inflammation of the serosal layer of the small bowel wall, is the most uncommon presentation of EGE. CASE SUMMARY A 30-year-old Egyptian woman presented with pain in the epigastrium and diffuse abdominal distension. Past medical history comprised allergy to iron injections (for iron deficiency anemia). Clinical examination showed moderate abdominal distention (palpation) and shifting dullness (percussion) suggestive of moderate ascites; mild right pleural effusion was also suspected, but findings were otherwise unremarkable. Abdominal and pelvic examinations by ultrasound and contrast-enhanced computed tomography showed moderate ascites, mild right pleural effusion, and diffuse thickening of the antrum and small bowel loops. Endoscopy of the upper gastrointestinal tract revealed mild diffuse hyperemia of the esophagus, stomach and duodenum, with no relevant findings in the histopathology of biopsy specimens taken from these sites. Laboratory results showed eosinophilia in the peripheral blood and marked increase of eosinophils in the ascitic fluid. Treatment with corticosteroids resulted in normalization of the laboratory test results, and the ascites resolved within a week of initiation of therapy. CONCLUSION Eosinophilic ascites, characterized by increased eosinophils in peripheral blood and ascitic fluid, showed dramatic response to steroid therapy.
Collapse
Affiliation(s)
- Ahmed El Ray
- Department of Hepatogastroenterology, Theodor Bilharz Research Institute, Giza, Egypt; Department of Pathology, Theodor Bilharz Research Institute, Giza, Egypt; Department of Tropical Medicine and Hepatogastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt; Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy-la-Garenne, CRI-UMR 1149, Inserm and Université de Paris, Paris, France.
| | - Ahmed Montasser
- Department of Hepatogastroenterology, Theodor Bilharz Research Institute, Giza, Egypt; Department of Pathology, Theodor Bilharz Research Institute, Giza, Egypt; Department of Tropical Medicine and Hepatogastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt; Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy-la-Garenne, CRI-UMR 1149, Inserm and Université de Paris, Paris, France
| | - Maged El Ghannam
- Department of Hepatogastroenterology, Theodor Bilharz Research Institute, Giza, Egypt; Department of Pathology, Theodor Bilharz Research Institute, Giza, Egypt; Department of Tropical Medicine and Hepatogastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt; Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy-la-Garenne, CRI-UMR 1149, Inserm and Université de Paris, Paris, France
| | - Salma El Ray
- Department of Hepatogastroenterology, Theodor Bilharz Research Institute, Giza, Egypt; Department of Pathology, Theodor Bilharz Research Institute, Giza, Egypt; Department of Tropical Medicine and Hepatogastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt; Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy-la-Garenne, CRI-UMR 1149, Inserm and Université de Paris, Paris, France
| | - Dominique Valla
- Department of Hepatogastroenterology, Theodor Bilharz Research Institute, Giza, Egypt; Department of Pathology, Theodor Bilharz Research Institute, Giza, Egypt; Department of Tropical Medicine and Hepatogastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt; Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy-la-Garenne, CRI-UMR 1149, Inserm and Université de Paris, Paris, France
| |
Collapse
|
2
|
Causes of eosinophilic ascites – A systematic review. ROMANIAN JOURNAL OF INTERNAL MEDICINE 2019; 57:110-124. [DOI: 10.2478/rjim-2018-0041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Indexed: 12/17/2022] Open
Abstract
Abstract
Background
. In the last years an uprising interest for a relatively unknown entity, eosinophilic ascites (EA), has been recorded.
Our aim is to investigate the potential causes of EA development, as well as clinical, laboratory, endoscopic and radiologic features, management and outcome in these patients.
Methods
. The following research was performed on PubMed (MEDLINE) database using the medical subject headings [Mesh] terms “Ascites” AND “Eosinophils”.
Results
. A total of 284 results, dating from 1962 onwards, were found and abstracts were examined. 131 papers were excluded and the remaining 153 publications, consisting in case reports and series of cases, were analyzed.
From 171 patients with EA, 127 subjects (74%) had EGE, 17 (10%) parasitic and fungal infections, 11(7%) Hypereosinophilic syndrome and 16 patients (9%) less common diseases (eosinophilic pancreatitis, chronic eosinophilic leukemia, myelofibrosis, T-cell lymphoma, Churg Strauss Syndrome, Systemic lupus erythematosus, Familial paroxysmal polyserositis and Ménétrier’s disease). High eosinophil blood count and IgE levels as well as gastrointestinal symptoms are frequent. The diagnosis is based on ascitic fluid analysis, imaging and endoscopic biopsies. Therapy with corticosteroids results in resolution of eosinophilic ascites in almost all patients.
Conclusion
. In most cases, in the absence of allergy, parasitic infections, malignancy, hematological disorders, peritoneal tuberculosis, inflammatory bowel disease or autoimmune disease, EA develops as a manifestation of eosinophilic gastroenteritis.
Collapse
|
3
|
Cheng LJ, Zhang SC. Abdominal ascites in children as the presentation of eosinophilic gastroenteritis: A surgeon's perspective. Clin Res Hepatol Gastroenterol 2019; 43:e12-e17. [PMID: 30528318 DOI: 10.1016/j.clinre.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/03/2018] [Accepted: 11/12/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Abdominal ascites is a common problem in general surgery. The causes include parasitic diseases, tuberculosis, malignancies, hypoalbuminemia, abdominal inflammatory diseases, and peritonitis. Eosinophilic gastroenteritis (EG) has also been reported to be an infrequent cause. To our knowledge, most instances of abdominal ascites from EG have occurred in adults and been reported by physicians or gastroenterologists. Herein, we report a small series of children who presented with eosinophilic ascites from a surgeon's perspective. METHODS Five children with EG (male: 3; female: 2) were selected for review of medical data and diagnostic reports. RESULTS The patients typically presented with intermittent abdominal pain (n = 5), diarrhea and nausea (n = 2), abdominal distension (n = 2), fever (n = 2), and histories of allergic disease (n = 3). Peripheral eosinophilia was regularly noted, three children showing elevated IgE levels. Abdominal ultrasound and CT performed in each instance demonstrated abdominal ascites. Surgical intervention was elected in two patients. Dietary control and a methylprednisolone regimen were then instituted in all children, followed by full clinical remissions. After a regular follow-up, all patients are doing well. CONCLUSIONS Surgeons should be aware of EG as a rare cause of ascites, even in a pediatric population and especially in children with strong histories of allergic diseases, peripheral blood eosinophilia, and/or family histories of EG. It is important to avoid unnecessary surgical intervention, because dietary control and methylprednisolone treatment are effective remedies.
Collapse
Affiliation(s)
- Lan-Jie Cheng
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, 36, Sanhao Street, Heping district, Shenyang 110004, PR China
| | - Shu-Cheng Zhang
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, 36, Sanhao Street, Heping district, Shenyang 110004, PR China.
| |
Collapse
|
5
|
Martín-Lagos Maldonado A, Alcazar Jaén LM, Benavente Fernández A. Eosinophilic ascites: A case report. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 41:372-374. [PMID: 29107390 DOI: 10.1016/j.gastrohep.2017.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 07/26/2017] [Accepted: 08/08/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Alicia Martín-Lagos Maldonado
- Unidad de Digestivo, Unidad de Gestión Clínica de Medicina Interna, Especialidades Médicas y Cuidados Paliativos, Hospital de Baza, AGS Nordeste de Granada, Baza, Granada, España.
| | - Luis Miguel Alcazar Jaén
- Unidad de Gestión Clínica de Medicina Interna, Hospital Gutierrez Ortega, Valdepeñas, Ciudad Real, España
| | - Alberto Benavente Fernández
- Unidad de Gestión Clínica de Medicina Interna, Especialidades Médicas y Cuidados Paliativos, Hospital de Baza, AGS Nordeste de Granada, Baza, Granada, España
| |
Collapse
|
6
|
Agrawal S, Vohra S, Rawat S, Kashyap V. Eosinophilic ascites: A diagnostic and therapeutic challenge. World J Gastrointest Surg 2016; 8:656-659. [PMID: 27721930 PMCID: PMC5037340 DOI: 10.4240/wjgs.v8.i9.656] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/12/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Eosinophilic gastroenteritis (EGE) is a rare condition characterized by eosinophilic infiltration of the gastrointestinal tract. Depending on the dominant layer of infiltration it is classified into three types namely, mucosal, muscularis and subserosal. The most uncommon variant is the subserosal type characterized by primarily subserosal disease, eosinophilic ascites and peripheral hypereosinophilia. The clinical features are non-specific with history of atopic predisposition and allergy. Endoscopic biopsy is frequently non-diagnostic due to an uninvolved gastrointestinal mucosa rendering its diagnosis a challenge. The mainstay of diagnosis is peripheral hypereosinophilia and eosinophil-rich ascitic fluid on diagnostic paracentesis. Oral steroid therapy is usually the first line of treatment with dramatic response. Due to a propensity for relapse, steroid-sparing therapy should be considered for relapses of EGE. We report a case of subserosal EGE with diagnostic clinical features and treatment response and review the current strategy in the management of eosinophilic ascites.
Collapse
|
7
|
Eosinophilic Gastroenteritis: Case Report and Review in Search for Diagnostic Key Points. Case Rep Gastrointest Med 2015; 2015:239506. [PMID: 26075112 PMCID: PMC4436468 DOI: 10.1155/2015/239506] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/21/2015] [Indexed: 12/21/2022] Open
Abstract
Eosinophilic
gastroenteritis is considered an uncommon
disease with a low incidence rate that remains
as a diagnostic challenge for the clinician, in
spite of the fact that seventy years have passed
since its original description. Hereby we
present the case of a 29-year-old male without
history of allergies who was evaluated for
unspecific gastrointestinal symptoms, without
relevant findings on physical examination and
presenting an initial complete blood count (CBC)
with severe eosinophilia. The patient was
evaluated and the diagnosis of eosinophilic
gastroenteritis was confirmed by
histopathological findings. The relevance of the
case resides in highlighting the lack of
guidelines or consensus for histological
diagnosis being virtually the only one
available. To a similar extent, treatment
evidence is based on case series with a
reasonable number of patients and case
reports.
Collapse
|