Case 2-2013: Eosinophilic Ascites (EA); Pathophysiology, Differential Diagnosis and Therapeutic Challenges

Walid Abd Eldayem,Ahmad Sherbini

doi:10.21608/aeji.2013.18257

Abstract

The 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 eosinophilic gastroenteritis (EGE) syndrome, which is characterized by presence of non specific abdominal complaints in association with eosinophil-driven inflammation of any or all layers of gut wall. Peripheral eosinophilia may or may not be present. Here, we report a case of EA, a rare of serosal variant of EGE that developed in a thirty years old Egyptian female. She complained initially from nonspecific GI symptoms associated with diffuse abdominal pain and distention for several weeks. Her physical examination was significant for moderate ascites. Initial work-up demonstrated: very high peripheral eosinophilia, normal liver function tests, thickening of small and large bowel walls, and normal total serum IgE. Upper endoscopy and extensive testing for malignancy and parasitic infections failed to establish a diagnosis. Ascetic fluid analysis showed significant eosinophilia. Further, a duodenal biopsy showed marked eosinophilic infiltration of lamina Propria. This report adds to scarce data on serosal involvement, the rarest form of presentation and illustrates that EGE complicated by ascites can be effectively treated with a combination therapy of steroids and leukotriene receptor antagonist Montelukast after other systemic disorders associated with peripheral eosinophilia have been ruled out. The pathophysiology, differential diagnosis as well as therapeutic challenges associated with EGE are discussed

Highlights

Eosinophilic gastrointestinal disease (EGE) is a rare chronic inflammatory bowel condition of unknown etiology that was originally described by Kaijser in 1937 [1]
As there is no clear treatment end point for montelukast in the literature, we intend to keep our patient on this safe drug for one year to avoid the commonly met with relapses after cessation of steroids
Eosinophilic gastroenteritis (EGE) is a rare condition characterized by recurrent [8] eosinophilic infiltration of portions of the gastrointestinal tract presenting with nonspecific GI symptoms in association with peripheral eosinophilia in most of the cases [9, 10]

Summary

INTRODUCTION

Eosinophilic gastrointestinal disease (EGE) is a rare chronic inflammatory bowel condition of unknown etiology that was originally described by Kaijser in 1937 [1]. Disorders characterized by inflammation rich in eosinophils without evidence of other known causes of eosinophilia (i.e., parasitic, infectious, drug reaction, or malignancy) [2]. Serosal involvement is rare, occurring in less than 13% of cases of EGE, and can result in abdominal pain and eosinophilic ascites (EA) [3]. Most reported cases of EA are idiopathic, often accompanied by an atopic condition, such as asthma, food or medication allergy. Abd Eldayem and Sherbini , Afro-Egypt J Infect Endem Dis 2013; 3(4): 146-152 www.mis.zu.edu.eg/ajied/home.aspx role in the recruitment of eosinophiles into the tissue causing damage .Disrupting this vicious circle provides the rationale for treating EGE patients with the leukotriene receptor antagonists (LTRA) [6, 7]

Case report

DISCUSSION

Findings

CONCLUSION

Presenting as Eosinophilic Ascites in a Young