A Case of Eosinophilic Esophagogastroenteritis with Transmural Involvement

Kim, Jong Dae; Im, Euyi Hyeog; Lee, Jung Ho; Lee, Tae Hee; Kim, Sun Moon; Choi, Young Woo; Kang, Young Woo

Abstract

Eosinophilic gastroenteritis is an uncommon disorder characterized by eosinophilic inflammation of the gastrointestinal tract that can present with various gastrointestinal manifestations, depending on the specific site of the affected gastrointestinal tract and the specific layer of the affected gastrointestinal wall. The depth of infiltration is the basis for a proposed classification as mucosal, muscular and serosal subtypes. Diagnostic criteria include the demonstration of eosinophilic infiltration of the bowel wall and lack of evidence of extra-intestinal disease. We experienced a 56-year-old woman that presented with postprandial epigastric pain and, 3 weeks later, with low abdominal pain. An abdominal examination showed tenderness and rebound tenderness in the whole abdomen and a hypoactive bowel sound. Endoscopy demonstrated the presence of mild edematous mucosa in the esophagus and stomach. There was eosinophilic infiltration in the esophagus, stomach and duodenum on as determined by a histological examination and muscular layer hypertrophy as determined on an endoscopic ultrasound examination. A CT scan showed wall thickening of the lower esophagus and gastric antrum to the mid-jejunum with mesenteric fat haziness, and a small amount of ascites was seen in the pelvic cavity. Eosinophilia was seen in the serum and from a fluid examination of aspirated fluid determined by culdocentesis. There was no evidence of parasitic infection based on a serum immunoassay and stool examination. The symptoms disappeared with oral prednisolone management and the patient was discharged from the hospital. This case showed continuous involvement from the lower esophagus to the mid-jejunum with transmural eosinophilic infiltration.