PRIMARY EOSINOPHILIC COLITIS WITH CONCOMITANT NEWLY DIAGNOSED INFLAMMATORY BOWEL DISEASE – A DIAGNOSITIC CONUNDRUM

Abstract

Eosinophilic colitis (EC) is a rare primary condition characterized by eosinophilic infiltration of the colon in the absence of secondary causes. Affecting only 0.003% of people in the United States, clinical manifestations of the disease can range from abdominal pain, bloody stools, and diarrhea to colonic obstruction, intussusception, volvulus, and perforation. The diagnosis is made upon histopathological analysis of colonic biopsies with the inflammatory infiltrate consisting predominantly or exclusively of eosinophils with focal collections greater than 100 per high-power field (hpf). Unlike inflammatory bowel disease (IBD), granulomas, crypt architectural distortion, pseudopyloric metaplasia, and fibrosis are not usually present with EC, but differentiating between the two conditions has proven to be difficult over the decades.