Eosinophilic enteritis: the great mimic

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Vol3Nr4Y2023
Published Dec 6, 2023
DOI: https://doi.org/10.22551/2023.41.1004.10271
Raluca-Ioana Avram http://orcid.org/0009-0003-6956-6686 Anca Victorita Trifan Irina Girleanu Simona Stefania Juncu Cristina Maria Muzica Ana-Maria Singeap Laura Huiban

Abstract

Eosinophilic enteritis (EoN), a subtype of eosinophilic gastrointestinal disease, is a rare and complicated inflammatory condition affecting the small intestine. This case report discusses a 42-year-old patient who presented with acute gastrointestinal symptoms including diarrhea, nausea, and vomiting. Initial laboratory investigations revealed leukocytosis, peripheral eosinophilia, and distinctive imaging findings, prompting further evaluation. Endoscopic evaluation revealed extensive mucosal lesions in the small intestine, with subsequent biopsies confirming eosinophilic infiltration, ultimately leading to the diagnosis of chronic enteritis, probably of an eosinophilic nature. The case highlights the complex differential diagnostic process involved in identifying EoN, which requires a comprehensive understanding of all the clinical and histopathological features of the disease. The efficacy of budesonide therapy is also discussed in the management of EoN and it was evidenced by our patient's positive response to treatment. This case report contributes significant insights into the understanding and management of EoN, providing essential information for the medical community to facilitate accurate diagnosis and tailored therapeutic interventions for individuals experiencing this complex disorder.

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Keywords

eosinophilic enteritis, chronic inflammatory disorder, eosinophilic infiltration, endoscopic evaluation, budesonide treatment

References
1. Dellon ES, Gonsalves N, Abonia JP, et al. International Consensus Recommendations for Eosinophilic Gastrointestinal Disease Nomenclature. Clin Gastroenterol Hepatol. 2022;20(11):2474-2484.e3. doi: 10.1016/j.cgh.2022.02.017. PMID: 35181570; PMCID: PMC9378753.
2. Mori A, Enweluzo C, Grier D, Badireddy M. Eosinophilic gastroenteritis: review of a rare and treatable disease of the gastrointestinal tract. Case Rep Gastroenterol. 2013;7(2):293-8. doi: 10.1159/000354147. PMID: 23904840; PMCID: PMC3728613.
3. Talley NJ, Shorter RG, Phillips SF, Zinsmeister AR. Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues. Gut. 1990;31(1):54-8. doi: 10.1136/gut.31.1.54. PMID: 2318432; PMCID: PMC1378340.
4. Lee M, Hodges WG, Huggins TL, Lee EL. Eosinophilic gastroenteritis. South Med J. 1996;89(2):189-94. doi: 10.1097/00007611-199602000-00006. PMID: 8578348.
5. Klein NC, Hargrove RL, Sleisenger MH, Jeffries GH. Eosinophilic gastroenteritis. Medicine (Baltimore). 1970;49(4):299-319. doi: 10.1097/00005792-197007000-00003. PMID: 5426746.
6. Keshavarzian A, Saverymuttu SH, Tai PC, et al. Activated eosinophils in familial eosinophilic gastroenteritis. Gastroenterology. 1985;88(4):1041-9. doi: 10.1016/s0016-5085(85)80026-3. PMID: 3918913.
7. Chang JY, Choung RS, Lee RM, et al. A shift in the clinical spectrum of eosinophilic gastroenteritis toward the mucosal disease type. Clin Gastroenterol Hepatol. 2010;8(8):669-75; quiz e88. doi: 10.1016/j.cgh.2010.04.022. PMID: 20451664.
8. Jensen ET, Martin CF, Kappelman MD, Dellon ES. Prevalence of Eosinophilic Gastritis, Gastroenteritis, and Colitis: Estimates From a National Administrative Database. J Pediatr Gastroenterol Nutr. 2016;62(1):36-42. doi: 10.1097/MPG.0000000000000865. PMID: 25988554; PMCID: PMC4654708.
9. Reed C, Woosley JT, Dellon ES. Clinical characteristics, treatment outcomes, and resource utilization in children and adults with eosinophilic gastroenteritis. Dig Liver Dis. 2015;47(3):197-201. doi: 10.1016/j.dld.2014.11.009. PMID: 25547198; PMCID: PMC4339627.
10. Collins MH. Histopathologic features of eosinophilic esophagitis and eosinophilic gastrointestinal diseases. Gastroenterol Clin North Am. 2014;43(2):257-68. doi: 10.1016/j.gtc.2014.02.007. PMID: 24813514.
11. Desreumaux P, Colombel JF. Diagnostic étiologique d'une éosinophilie digestive. Rev Prat. 1992;171:668–73.
12. Khan S. Eosinophilic gastroenteritis. Best Pract Res Clin Gastroenterol. 2005;19(2):177-98. doi: 10.1016/j.bpg.2005.01.009. PMID: 15833687.
13. Kaijser R. Zur Kenntnis der allergischen Affektionen des Verdauugskanals vom Standpunkt des Chirurgen aus. Arch Klin Chir. 1937;188:36–64.
14. Zuo L, Rothenberg ME. Gastrointestinal eosinophilia. Immunol Allergy Clin North Am. 2007;27(3):443-55. doi: 10.1016/j.iac.2007.06.002. PMID: 17868858; PMCID: PMC2034402.
15. Pineton de Chambrun G, Dufour G, Tassy B, et al. Diagnosis, Natural History and Treatment of Eosinophilic Enteritis: a Review. Curr Gastroenterol Rep. 2018;20(8):37. doi: 10.1007/s11894-018-0645-6. PMID: 29968127.
16. Min KU, Metcalf DD. Eosinophilic gastroenteritis. Immunol Allergy Clin North Am. 1991; 11:799. doi: 10.1016/S0889-8561(22)00076-5
17. Pineton de Chambrun G, Gonzalez F, Canva JY, et al. Natural history of eosinophilic gastroenteritis. Clin Gastroenterol Hepatol. 2011;9(11):950-956.e1. doi: 10.1016/j.cgh.2011.07.017. PMID: 21806952.
18. Coton T. Gastroentérite à éosinophiles. Encyclopédie Médicochirurgicale. 2009;[9–089-C-40].
19. Navab F, Kleinman MS, Algazy K, Schenk E, Turner MD. Endoscopic diagnosis of eosinophilic gastritis. Gastrointest Endosc. 1972;19(2):67-9. doi: 10.1016/s0016-5107(72)73955-3. PMID: 4648828.
20. Endo H, Hosono K, Inamori M, et al. Capsule endoscopic evaluation of eosinophilic enteritis before and after treatment. Digestion. 2011;83(1-2):134-5. doi: 10.1159/000308654. PMID: 21042024.
21. Attar A, Cazals-Hatem D, Ponsot P. Videocapsule endoscopy identifies stenoses missed by other imaging techniques in a patient with eosinophilic gastroenteritis. Clin Gastroenterol Hepatol. 2011;9(1):A28. doi: 10.1016/j.cgh.2010.07.021. PMID: 20728576.
22. Busoni VB, Lifschitz C, Christiansen S, G de Davila MT, Orsi M. Gastroenteropatía eosinofílica: una serie pediátrica [Eosinophilic gastroenteropathy: a pediatric series]. Arch Argent Pediatr. 2011;109(1):68-73. Spanish. doi: 10.1590/S0325-00752011000100019. PMID: 21283948.
23. Elsing C, Placke J, Gross-Weege W. Budesonide for the treatment of obstructive eosinophilic jejunitis. Z Gastroenterol. 2007;45(2):187-9. doi: 10.1055/s-2006-927138. PMID: 17304405.
24. Lombardi C, Salmi A, Passalacqua G. An adult case of eosinophilic pyloric stenosis maintained on remission with oral budesonide. Eur Ann Allergy Clin Immunol. 2011;43(1):29-30. PMID: 21409859.
25. Lombardi C, Salmi A, Savio A, Passalacqua G. Localized eosinophilic ileitis with mastocytosis successfully treated with oral budesonide. Allergy. 2007;62(11):1343-5. doi: 10.1111/j.1398-9995.2007.01461.x. PMID: 17919149.
How to Cite
Avram, R.-I., Trifan, A. V., Girleanu, I., Juncu, S. S., Muzica, C. M., Singeap, A.-M., & Huiban, L. (2023). Eosinophilic enteritis: the great mimic. Archive of Clinical Cases, 10(4), Arch Clin Cases. 2023;10(4):183-186. https://doi.org/10.22551/2023.41.1004.10271
Issue
Vol. 10 No. 4 (2023)
Section
Case Reports

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How to Cite

Avram, R.-I., Trifan, A. V., Girleanu, I., Juncu, S. S., Muzica, C. M., Singeap, A.-M., & Huiban, L. (2023). Eosinophilic enteritis: the great mimic. Archive of Clinical Cases, 10(4), Arch Clin Cases. 2023;10(4):183-186. https://doi.org/10.22551/2023.41.1004.10271