Allergy Asthma Respir Dis.  2014 Jul;2(3):222-226. 10.4168/aard.2014.2.3.222.

Eosinophilic cholecystitis: A rare manifestation of hypereosinophilic syndrome

• Park JH
• Kim BH
• Kim MK
• Lee JE
• Kim KT
• Yoo JJ
• Kim HJ
• Jung SW
• Kim CH
• Hyun IG
• Choi JH

• KMID: 2262524
• DOI: http://doi.org/10.4168/aard.2014.2.3.222

Abstract

Eosinophilic cholecystitis (EC) is a rare form of acute cholecystitis, of which diagnosis is based on classical symptoms of cholecystitis with a presence of >90% eosinophilic infiltration within the gall bladder. EC rarely manifests in idiopathic hypereosinophilic syndrome (IHES). Here, we report two cases of EC with IHES. One is a 57-year-old male who presented with acute right upper quadrant (RUQ) pain, jaundice and fever. The initial peripheral blood eosinophil count was 2,070/mm3, and further elevated to 12,590/mm3. Acute acalculous cholecystitis with cholangitis was confirmed by computed tomography (CT). He improved with endocopic nasobiliary drainage and antibiotic therapy. The other is a 64-year-old female who presented with acute RUQ pain. She also complained of dyspnea and tingling sensation of both hands and feet. The initial peripheral blood eosinophil count was 10,400/mm3. Abdominal CT revealed findings suggestive of acute acalculous cholecystitis. She improved with systemic glucocorticosteroid therapy. No other causes of hypereosinophilia were found in either patients. Thus, cholecystectomy may not be mandatory for the treatment of EC with IHES.

Keyword

Hypereosinophilic syndrome; Cholecystitis; Cholangitis

MeSH Terms

Acalculous Cholecystitis
Cholangitis
Cholecystectomy
Cholecystitis*
Cholecystitis, Acute
Diagnosis
Drainage
Dyspnea
Eosinophils*
Female
Fever
Foot
Hand
Humans
Hypereosinophilic Syndrome*
Jaundice
Male
Middle Aged
Sensation
Tomography, X-Ray Computed
Urinary Bladder

Figure

• 

  Fig. 1 (A) Abdominal computed tomography shows diffuse wall thickening and mild dilatation of gall bladder and common bile duct which is compatible with acute cholangitis and cholecystitis. (B) Endoscopic retrograde cholangiopancreatography shows normal passage of bile. There is not any filling defect in gall bladder and bile duct by stone or mass. (C) Esophagogastroduodenoscopic biopsy shows diffuse eosinophilic infiltration (>50/high power field) in the stomach (H&E, ×400).

• 

  Fig. 2 Clinical course of the patients. Total bilirubin (T. Bil) level (●) was gradually recoverd after endoscopic nasobiliary drainage (ENBD) insertion. Total peripheral eosinophil count (■) was also recovered from hospital day 8.

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  Fig. 3 Abdominal computed tomography (A) and magnetic resonance cholangiopancreatography (B) show mild distension and wall thickening of gall bladder (GB) and mild dilatation of common bile duct (CBD), which is compatible with acute cholecystitis. There are not GB or CBD stones.

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  Fig. 4 The progress of peripheral blood eosinophil count of the patient according to treatment. MPD, methylprednisolone.

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