No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Acute eosinophilic ascites: An unusual form of an unusual case
Abstract
Eosinophilic gastroenteritis (EGE) is an uncommon disease characterised by eosinophilic infiltration in the gastrointestinal tract. EGE may involve more than one layer of the gastrointestinal tract. Clinical features depend on the layer and location which is involved. We report an unusual case of eosinophilic ascites associated with antinuclear antibody positivity, which is an unusual variety of serosal form of EGE.
... In 19 cases, although multiple biopsies were performed, their results revealed normal mucosa. Because of negative biopsy results in the absence of pathological features at abdominal echo, CT scans or endoscopy, in 6 subjects [17][18][50][51][52][53] laparoscopy with peritoneal biopsies provided valuable information to achieve a definite diagnosis. In 3 patients surgery was not performed, and the diagnosis was established according to clinical and biological criteria [33,[54][55]. ...
... In 10 out of 19 cases with endoscopic lesions (1) [34], peritoneal involvement (1) [15], gastrointestinal wall thickening (3) [49,[57][58], endoscopic lesions with gastrointestinal wall thickening (1) [59], as well as in peritoneal involvement and gastrointestinal wall thickening association (1) [ [63][64]. Associations between EGE and autoimmune diseases were described in 3 patients: one with systemic lupus erythematosus [65], one with lupusscleroderma overlap syndrome and heterozygous bthalassemia [57], and another one presenting positive antinuclear antibodies [50]. ...
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.
... The typical clinical picture comprises abdominal pain, vomiting, early satiation, diarrhea and weight loss (infiltration of eosinophils in the mucosal layer), intestinal paralysis (involved muscle layer) and ascites (serosal layer). Histopathological confirmation of eosinophilic infiltration is required for the conclusive diagnosis (7)(8)(9)(10) . ...
... Typowymi objawami klinicznymi są bóle brzucha, wymioty, wczesne uczucie sytości, biegunka i ubytek masy ciała (postać śluzówkowa), objawy niedrożności (postać mięśniowa) czy wodobrzusze (postać surowicza). Do postawienia diagnozy wymagane jest jednak histopatologiczne potwierdzenie nacieków eozynofilowych (7)(8)(9)(10) . ...
Ascites with elevated serum CA-125 but without suspicious adnexal masses is a diagnostic challenge. The differential diagnosis of patients aged 20-50 years old presenting with ascites should account for rare etiologies, such as the hypereosinophilic syndrome. A 37-year-old patient was referred to the Gynecologic Oncology Outpatient Clinic of the University Hospital in Krakow due to rapidly progressing ascites with serum CA-125 above the normal limit. Thorough imaging studies showed no evidence of malignant ascites, whilst hypereosinophilia was detected in laboratory tests. After ruling out other causes of primary and reactive hypereosinophilia, the diagnosis of the hypereosinophilic syndrome was made. After the administration of oral corticosteroid therapy, complete resolution of symptoms (including ascites) was achieved, and CA-125 level returned to normal. Currently, the patient is asymptomatic and is followed up at the Autoimmune Diseases Outpatient Clinic.
... В лабораторных исследованиях могут быть выявлены эозинофилия, гипоальбуминемия, повышенный уровень IgE, железодефицитная анемия. В некоторых случаях обнаруживаются антинуклеарные антитела, кристаллы Шарко -Лейдена в кале [60,[62][63][64]. ...
According to the frequency of seeking medical care, diarrhea is one of the most common complaints, being an important health problem. Acute diarrhea, as a rule, is infectious in nature, thus, the scope of diagnostics is aimed at assessing the patient's condition and clarifying the pathogen etiology. Chronic diarrhea has a diverse etiology, which poses a difficult task for the clinician to conduct differential diagnosis. Therefore, most guidelines on the relevant problem suggest the use of medical algorithms aimed at step-by-step exclusion of diseases accompanied by diarrhea: from the most common causes to the more rare ones. First of all, it is necessary to detail complaints, identify the presence of red flags, collect an epidemiological, drug and hereditary history, assess the nutrition habits, dietary preferences of the patient and their possible association with the manifestation of diarrhea. The general examination reveals signs of dehydration and malabsorption, as well as the presence of stigma of the underlying disease. Also, at the first stage, it is advisable to conduct the minimum necessary laboratory and instrumental studies. Subsequently, if there are difficulties in establishing the diagnosis, it is advised to re-assess the clinical picture and prescribe additional examination methods. Alongside this, symptomatic and pathogenetic therapy, dehydration, timely detection and correction of electrolyte disorders should be indicated for all patients with acute and chronic diarrhea at the stage of further examination and diagnosis confirmation. KEYWORDS: acute diarrhea, chronic diarrhea, diagnostic algorithm, celiac disease, intestinal tuberculosis, ischemic colitis, radiation colitis, eosinophilic colitis, microscopic colitis, Whipple disease. FOR CITATION: Livzan M.A., Gaus O.V., Gavrilenko D.A. Diarrheal syndrome in the practice of a general practitioner: medical algorithm. Russian Medical Inquiry. 2023;7(5):300–309 (in Russ.). DOI: 10.32364/2587-6821-2023-7-5-8.
... A previously reported case has serosal involvement in the form of eosinophilic ascites along with positivity for antinuclear antibodies. 7 Endoscopic ultrasonography has been used in adults occasionally to confirm the diagnosis of EGE, 8 but has not been reported in children. It is an attractive modality in this population as it avoids both radiation and contrast. ...
Eosinophilic ascites, owing to serosal involvement, is a very rare manifestation of eosinophilic gastroenteritis in children, especially when it occurs with muscular involvement in the absence of mucosal disease, which may be confirmed by endoscopic ultrasonography. An 11-year-old girl, presenting with massive eosinophilic ascites and colicky abdominal pain with peripheral eosinophilia, raised IgE levels and positive skin prick test, had such investigation which confirmed the presence of muscle layer thickening of both stomach and small bowel. She responded well to steroids and montelukast.
Massive ascites of unknown origin is a rare condition with a wide differential diagnosis, so our goal is to illustrate the diagnostic process performed to achieve it in an orderly and logical way. Specifically, our patient is a young woman without a history of interest with ascites of slow progression until becoming massive and refractory to medical treatment, requiring the performance of various complementary tests that finally led to a laparoscopic approach to obtain the etiological diagnosis, being secondary to a giant splenic pseudocyst secondary to cavernous hemangioma with reactive mesothelial hyperplasia.
ARTÍCULO DE REVISIÓNActA MédicA Grupo ÁnGeles. Volumen 13, No. 4, octubre-diciembre 2015238www.medigraphic.org.mxINTRODUCCIÓNLa gastroenteritis eosinofílica1,2 (GE) es una entidad clínico-patológica poco frecuente del tubo digestivo;3 la descripción inicial fue hecha por Kaijser4 en 1937. El cuadro puede afec-tar tanto a niños5 como a adultos, siendo la tercera y cuarta décadas de la vida en donde se encuentra el mayor número de pacientes. Clínicamente se caracteriza por dolor abdomi-nal difuso, diarrea, náusea, vómitos, sensación de plenitud asociadas a eosinofilia periférica; su sintomatología puede variar6 dependiendo de la profundidad de afección de las láminas del tubo digestivo. Ante la sospecha clínica, debe efectuarse biopsia del área afectada, pues el diagnóstico es histopatológico, confirmando la infiltración eosinofílica de una o más áreas del tracto gastrointestinal, sin infiltración de otros órganos. Al presentarse una persona con sintomatología de tubo digestivo asociada a eosinofilia en sangre periférica, en quien se llegó al diagnóstico de GE, nos dimos a la tarea de presentar el caso, siendo el motivo de esta comunicación.*Especialista en Medicina Interna. Adscrito al Servicio de Medicina Interna del Hospital Ángeles León.‡Gastroenterólogo Endoscopista. Adscrito al Servicio de Gas-troenterología del Hospital Ángeles León.§Anatomopatólogo. Jefe del Departamento de Patología del Hospital Ángeles León.IIEspecialista en Medicina de Rehabilitación. Profesor de la Facultad de Medicina de León, Universidad de Guanajuato. México.Correspondencia:Dr. Gregorio Arellano AguilarCorreo electrónico: gregareag@gmail.comAceptado: 25-08-2015.Este artículo puede ser consultado en versión completa en http://www.medigraphic.com/actamedicaGastroenteritis eosinofílicaGregorio Arellano-Aguilar,* Francisco Ramírez-Arias,‡José Aguirre-Trigueros,§ Luis Gerardo Domínguez-CarrilloIISummaryEosinophilic gastroenteritis is an inflammatory disorder characterized by eosinophilic infiltration of the stomach and duodenum, and, in some cases, the esophagus and colon; it is a rare disorder that typically presents in the third decade. The pathogenesis of EG is not well understood, but epidemiologic and clinical features suggest an allergic component. EG should be suspected in a patient with abdominal pain, nausea, vomiting, early satiety, diarrhea, weight loss, or ascites that are associated with periph-eral eosinophilia and/or a history of food allergy or food intolerance. Its natural history is not well defined. Clinical findings are related to the location and spread of intestine affected by eosinophilic infiltration. Diagnosis depends on the presence of gastrointestinal tract eosinophilic infiltration in biopsy and/or ascites fluid, with absence of eosinophilia in other organs. Treatment is established with diet and steroids, but with limited evidence on symptoms severity and malabsorption presence.Key words: Eosinophilic gastroenteritis.ResumenLa gastroenteritis eosinofílica es un trastorno inflamatorio del tubo digestivo caracterizado por infiltración eosinofí-lica del estómago y el duodeno y, en algunos casos, del esófago y el colon; es un trastorno poco común que se presenta en la tercera década. Su etiopatogenia y las características clínicas sugieren un componente alérgico. Debe sospecharse en pacientes con dolor abdominal, náuseas, vómitos, saciedad precoz, diarrea, pérdida de peso o ascitis que están asociados con eosinofilia perifé-rica y/o antecedentes de alergia o intolerancia a algunos alimentos. Su historia natural no está bien definida. Los hallazgos clínicos están relacionados con la localización, amplitud y láminas del intestino afectadas por la infiltración de eosinófilos. El diagnóstico se basa en la presencia de infiltración eosinofílica del tracto gastrointestinal en la biopsia y/o líquido de ascitis, con ausencia de eosinofilia en otros órganos. El manejo con dieta y esteroides se basa en evidencia limitada en la severidad de los síntomas y la presencia de mala absorción.Palabras clave: Gastroenteritis eosinofílica
Gastroenteritis eosinofílica. Available from: https://www.researchgate.net/publication/287996886_Gastroenteritis_eosinofilica [accessed Apr 13 2018].
Systemic lupus erythematosus (SLE) is a multisystem disorder that may present with various symptoms. It may involve the gastrointestinal tract in a variety of ways; some of the most well-known ones are transaminitis, lupus mesenteric vasculitis, lupus enteritis and mesenteric vascular leakage. We describe a case of a patient with SLE who presented with a five-month history of diarrhea caused by eosinophilic enteritis. To the best of our knowledge, there are few cases reported in the literature of patients with SLE who initially present with chronic diarrhea due to eosinophilic enteritis.
A 38-year-old Persian Iranian woman was admitted with a five-month history of diarrhea and abdominal pain. A physical examination showed nothing abnormal. Initially, she had only lymphopenia and mild eosinophilia. No autoimmune or infectious etiology was detected to justify these abnormalities. A thorough evaluation was not helpful in finding the etiology, until she developed a scalp lesion similar to discoid lupus erythematosus. Computed tomography showed small bowel wall thickening. Briefly, she manifested full-blown SLE, and it was revealed that the diarrhea was caused by eosinophilic enteritis.
Considering SLE in a patient who presents with chronic diarrhea and lymphopenia may be helpful in earlier diagnosis and therapy. This is an original case report of interest to physicians who practice internal medicine, family medicine and gastroenterology.
Eosinophilic ascites (EA) is a rare disorder of unknown etiology that has been reported in both adult and pediatric patients. It is a part of the syndrome of eosinophilic gastroenteritis, which is characterized by eosinophilic infiltration of any or all layers of the gut wall and may involve any segment of the gastrointestinal tract. Peripheral eosinophilia may or may not be present. We report a case of EA that developed post partum.
The aim of this study was to evaluate the clinicopathological spectrum of eosinophilic gastroenteritis and identify possible difficulties in establishing the diagnosis. All patients with a diagnosis of eosinophilic gastroenteritis, defined by the presence of gastrointestinal symptoms and eosinophilic infiltration of the gut (38), or a radiological diagnosis with peripheral eosinophilia (two), were identified from the Mayo Clinic records; in none was there evidence of extraintestinal disease. Patients were divided into three groups according to the Klein classification: predominant mucosal (23), muscular (12), or subserosal disease (five). A fourth group of patients (10) for comparison had abdominal symptoms and unexplained peripheral eosinophilia but no proven eosinophilic infiltration of the gut. It was found that a history of allergy was reported by 20 of 40 patients with eosinophilic gastroenteritis. Peripheral eosinophilia was absent in nine of 40. The patients with subserosal disease were distinct from the other groups in presentation (abdominal bloating, ascites), higher eosinophil counts and in their dramatic responses to steroid therapy. Otherwise the patients were similar regarding demographic factors, presenting symptoms (abdominal pain, nausea, weight loss, diarrhoea), and laboratory parameters. The ESR was moderately raised in 10 of 40 patients. The disease may affect any area of the gastrointestinal tract; eosinophilic infiltration was documented in the oesophagus in one patient and in the colon in two cases. Endoscopic biopsies missed the diagnosis in five of 40 presumably because of patchy disease. Eosinophilic gastroenteritis should be considered in the differential diagnosis of unexplained gastrointestinal symptoms even in the absence of peripheral eosinophilia.
Eosinophilic gastroenteritis is an infrequent entity characterized by tissular eosinophilia that can affect different layers of the intestinal wall. This entity can affect any area of the digestive apparatus from the esophagus to the rectum. Clinical manifestations depend on the affected layers and range from barely perceptible symptoms to intestinal obstruction or ascites. We present the case of an 18-year-old woman who showed abdominal ascites as a rare form of presentation with difficult differential diagnosis with peritoneal carcinomatosis.
Two new cases of eosinophilic ascites and a brief review of 40 cases found in the literature are presented. In three quarters of the cases eosinophilic ascites affects women aged 40 years on average. Because the patients present with a history of allergy (55 %), blood hypereosinophilia (69 %), associated pleural effusion (11 %), gastrointestinal disorders and, above all, eosinophilic infiltrations in the walls of the digestive tract or the serous membranes (63 %), this pathology may be regarded as a clinical form or eosinophilic gastroenteritis. The outcome is favourable in 90 % of the cases ; relapses occur in 26 %. ls eosinophilic gastroenteritis and independent pathological entity, or should it be considered a minor clinical form of Chusid's idiopathic hypereosinophilic syndrome? The lack of decisive arguments precludes a firm conclusion.
A previously unrecognized subgroup of "eosinophilic gastroenteritis" is described which is associated with connective tissue diseases. Large numbers of mast cells and a distinctive pattern of tissue involvement are characteristic morphologic features. Recognition of this entity has potentially important diagnostic and pathogenic implications.
The goal to create a standardized diagnostic classification scheme of food-related gastrointestinal hypersensitivity disease syndromes included the diagnosis of eosinophilic gastroenteritis. This article reviews the history of this diagnosis and the current concepts of this complex disorder. The common symptoms from the literature are discussed. Because no standards for this diagnosis exist, the wide variety of diagnostic criteria from the literature are presented. No consistent immunologic abnormalities have been associated with the diagnosis of eosinophilic gastroenteritis in the literature. A review of the current immunologic concepts associated with the diagnosis of eosinophilic gastroenteritis is presented. The history of this disorder, which spans more than 6 decades is also discussed. The contributions made by the original authors during this period are presented. Attention was directed to the variety of clinical features associated with this disorder, but particular attention was paid to the evolution of the pathophysiologic mechanisms proposed. Some of the difficulties associated with the prospective study of patients with eosinophilic gastroenteritis are also discussed. The establishment of appropriate control populations, as well as the fundamental difficulties encountered with the establishment of the certainty of the link between abnormal immunohistochemical findings, and initial clinical symptoms are presented and discussed. A new classification system is proposed for food-related gastrointestinal hypersensitivity disease syndromes. Age, symptoms, and the region of the gastrointestinal tract involved were the variables that were considered most important by consensus opinion. Finally, recommendations to refocus our collective investigative efforts are presented.
A world wide web database was established that tracked features of eosinophil-associated gastrointestinal disorders; 80% had coexisting atopic disease, 62% had food sensitization, and 16% had an immediate family member with a similar disorder. Developmental delay, seizure disorders, and congenital anomalies were seen in a proportion of respondents. The world wide web has proven to be an efficient tool to gather patient information, allowing us to define distinguishing features of various eosinophil-associated gastrointestinal disorders and to establish that these disorders have strong genetic and allergic components.
Eosinophilic gastroenteritis is an infrequent entity characterized by tissular eosinophilia that can affect different layers of the intestinal wall. This entity can affect any area of the digestive apparatus from the esophagus to the rectum. Clinical manifestations depend on the affected layers and range from barely perceptible symptoms to intestinal obstruction or ascites. We present the case of an 18-year-old woman who showed abdominal ascites as a rare form of presentation with difficult differential diagnosis with peritoneal carcinomatosis.
Eosinophilic gastroenteritis is an uncommon disease with an obscure etiology, although associations with allergy, the idiopathic hypereosinophilic syndrome, and connective tissue disease have been reported. We present the case of a 37-year-old woman with a history of idiopathic thrombocytopenic purpura who presented with refractory nausea, vomiting, and abdominal pain. Imaging studies were significant for bowel wall thickening and ascites, while laboratory studies revealed a positive antinuclear antibody (ANA), a positive anti-double stranded (DS) DNA antibody, low complement, and proteinuria. Exploratory laparotomy with gastric and small bowel biopsies established the diagnosis of eosinophilic gastroenteritis. In addition, the patient met clinical criteria for the diagnosis of systemic lupus erythematosus. Previous studies have described eosinophilic gastroenteritis in patients with scleroderma, polymyositis, or dermatomyositis. This is the first report to our knowledge of an individual with eosinophilic gastroenteritis and systemic lupus erythematosus.