Eosinophilic Colitis Presenting with Chronic Diarrhea

Hendra Koncoro,Renaningtyas Tambun,Rafael Eddy Setijoso

doi:10.24871/191201852-55

Abstract

Eosinophilic colitis (EC) is a rare disease which characterized by infiltration of eosinophil in colon and peripheral eosinophilia. Other causes of peripheral eosinophilia need to be excluded before assumed EC such as food allergy, inflammatory bowel disease, or parasites. It has bimodal distribution, peaked at neonates and young adult. A 24-year-old man was admitted with abdominal pain and chronic diarrhea. He has no any disease, food, pollen, or drug allergy in his medical history. Leukocyte: 29,000/mm3 (neutrophil: 43.4%, eosinophil: 44.4%, lymphocyte: 8.2%), platelet: 453,000/mm3, total eosinophil: 17,582.1/μL (normal range: 50-300), immunoglobulin E: 1000 IU/mL (normal range 100 IU/mL) was counted in his blood examination. The colon biopsy was reported as eosinophilic colitis. We applied methylprednisolone 24 mg/day. With this treatment, the patient’s symptoms regressed. EC may involve any part of the gastrointestinal tract. An intense inflammatory infiltrate, consisting predominantly of eosinophils penetrates into one or more layers of the gastrointestinal tract. In 1937, Kaijser described this disorder. EC is classified into mucosal, submucosal or muscular, and serosal types. The endoscopic findings may vary from normal mucosa to frank ulceration. Our patient had chronic diarrhea and peripheral eosinophilia which are typical features of the mucosal types. It should be put in differential diagnosis in patients with chronic diarrhea.

Highlights

Eosinophilic colitis (EC) is a rare disease which are part of primary eosinophilic gastrointestinal disorders (EGIDs).[1]
Besides EC, EGIDs consisted of eosinophilic esophagitis (EE) and eosinophilic gastroenteritis (EG).[2]
It is defined by three criteria: (1) Occurrence of gastrointestinal symptoms; (2) Biopsies showing eosinophilic infiltration of one or more areas of the gastrointestinal tract from oesophagus to colon, or characteristic radiological findings with peripheral eosinophilia; (3) No evidence of parasitic or extraintestinal disease.[6]

Summary

INTRODUCTION

Eosinophilic colitis (EC) is a rare disease which are part of primary eosinophilic gastrointestinal disorders (EGIDs).[1]. There has been an exponential rise in EC yielding 196 cases reported over the past decade.[3] The standardized estimated prevalences of EC were 3.3/100,000.4 It is characterized by eosinophilic-rich infiltration and peripheral eosinophilia. EC was first identified by Kaijser et al in 1937 It is defined by three criteria: (1) Occurrence of gastrointestinal symptoms; (2) Biopsies showing eosinophilic infiltration of one or more areas of the gastrointestinal tract from oesophagus to colon, or characteristic radiological findings with peripheral eosinophilia; (3) No evidence of parasitic or extraintestinal disease.[6] Approximately 40% of cases were reported to have an underlying allergic basis.

CASE ILLUSTRATION

DISCUSSION