Serosal eosinophilic gastroenteritis - Rare cause for abdominal pain, and new onset ascites

Excerpt

A 23-year-old female patient with colicky abdominal pain, exacerbated post-prandially, presented to our hospital. Initial blood investigation and ultrasound abdomen were within normal limit except peripheral eosinophilia. Absolute eosinophil count was 2725/mm³. Patient did not have a history of atopy/allergy. Albendazole and ivermectin were administered on the initial presentation. Further investigation for peripheral eosinophilia yielded negative results, including stool parasite examination, Filarial polymerase chain reaction (PCR), perinuclear - antineutrophil cytoplasmic autoantibody, cytoplasmic – antineutrophil cytoplasmic autoantibody, peripheral smear for immature myeloid cell and tumor markers (cancer antigen -19-9, carcinoembryonic antigen, cancer antigen-125, alpha-fetoprotein). Contrast-enhanced computed tomography enterography revealed long segment circumferential mild thickening of distal duodenum and proximal jejunum (Fig. 1a, white arrows). However, endoscopy did not reveal any mucosal abnormality in duodenum and proximal jejunum (Fig. 1b). Random biopsy from distal duodenum and proximal jejunum (to rule out eosinophilic gastroenteritis) showed normal findings. No strongyloides were observed on duodenal biopsy (Fig. 1c). Repeat ultrasound of the abdomen revealed new onset moderate ascites. A diagnostic paracentesis revealed high protein, low serum ascites albumin gradient (SAAG) and highly cellular fluid. Ascitic fluid total count was 7800/mm³ and 98% eosinophils in differential count. Ascitic fluid cytology did not show any malignant cells (Fig. 1d). The diagnosis of serosal eosinophilic gastroenteritis was made. The patient was treated with prednisolone 40 mg for 15 days followed by tapering dose over eight weeks. The symptoms and ascites resolved after two weeks of steroid therapy. The patient remained asymptomatic at three-month follow-up.

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