Eosinophilic Colitis Masquerading as Malignancy of Colon

Abstract

A 78-year-old woman presented to the ER with the chief complaint of generalized, dull abdominal pain for three days duration. She described the pain to be continuous and not related to eating. The patient also reported multiple episodes of hematochezia for a week preceding the presentation. The patient noted weight loss of about 30 pounds over a six month period. The patient denied having any diarrhea. Her medical comorbidities included hypertension, diabetes mellitus type 2, coronary artery disease, bronchial asthma and End-stage Renal Disease (ESRD) requiring renal replacement therapy. Laboratory values were significant for normocytic normochromic anemia with hemoglobin of 11 grams/dL and mild eosinophilia with a count of 0.4x103/uL. Patient underwent a Computerized Tomography (CT) scan of abdomen and pelvis which showed a focal circumferential mass like thickening in the colon with paracolic infiltration (Figure-1). A colonoscopy revealed discontiguous areas of circumferential ulcerated, friable mucosa from hepatic flexure to descending colon (Figure-2). Biopsies from these areas showed numerous eosinophils within the lamina propria suggestive of eosinophilic colitis (Figure-3). EC (Eosinophilic colitis) is the rarest form of eosinophilic gastroenteritis. It is more commonly seen in neonates and children. However, there have been a few cases of EC reported in adults predominantly in their third and fourth decades of life. Estimating the true incidence of primary EC is challenging given its rare nature, and also since secondary EC can occur in a multitude of other chronic conditions such as food allergies and inflammatory bowel diseases. Symptoms of EC usually include abdominal pain, diarrhea, bleeding, weight loss, obstruction, and in more severe cases ascites. Transmural disease has been reported to be associated with intestinal obstruction, intussusception, and even perforation. Colonic distention, thickening of the bowel wall and ulcerated lesions mimicking Crohn disease have been reported, as seen in our patient. On colonoscopy, signs of colitis such as mucosal erythema, edema, and ulcerated lesions are often evident. The management of eosinophilic gastroenteritis varies, depending on the underlying condition. Eosinophilic gastroenteritis associated with peripheral eosinophilia and positive IgE- is often caused by food allergy and was shown to respond to diet restriction. For other etiologies, corticosteroids remain the mainstay of therapy.Figure 1Figure 2Figure 3