Tapeworm-Induced Eosinophilic Colitis: A Case Report

A Mysterious Case of Abdominal Pain

Objective. In recent years, several key consensus documents have been published on eosinophilic gastrointestinal disorders (EGIDs). This review aims to analyze the literature and discuss core concepts, including terminology and classification, etiology, pathogenesis, and treatment of eosinophilic gastritis, enteritis, and colitis. Key points. Eosinophilic gastrointestinal disorders are a group of immune-mediated diseases of unknown etiology, characterized by eosinophilic infiltration of the walls of hollow gastrointestinal organs—from the mucosa to the serosa—resulting in significant clinical symptoms, endoscopic findings, and, in some cases, complications such as perforation, bleeding, ascites, or intestinal obstruction. The first consensus document on EGIDs (2022) proposed standardized nomenclature based on the affected site: eosinophilic esophagitis, eosinophilic gastritis, eosinophilic enteritis, and eosinophilic colitis. The clinical presentation is highly variable and non-specific, depending on the depth of inflammation (mucosal, muscular, or serosal). Validated endoscopic criteria for eosinophilic involvement of the stomach and intestines are not currently available. Diagnosis of eosinophilic gastritis, enteritis, or colitis is based on clinical presentation, endoscopic findings, and multifocal mucosal biopsy followed by histological evaluation. There are no established treatment guidelines; empiric approaches include systemic and topical glucocorticoids, biologic therapies, and elimination diets. Conclusion. The diagnosis of eosinophilic gastric and intestinal diseases remains challenging due to non-specific clinical and endoscopic features and the absence of clear histopathological criteria. These conditions are rare and not widely recognized in clinical practice. Current treatment strategies include dietary therapy, corticosteroids, and targeted biologic agents.

Eosinophils are important effector cells of the innate immune system. Eosinophilic infiltrative disorders of the gastrointestinal tract, though recognised for decades, have recently witnessed a resurgence of interest, particularly for...

Further description of the development of the digestive organs in Atlantic halibut (Hippoglossus hippoglossus) larvae, with notes on differential absorption of copepod and Artemia prey

INTRODUCTION: Eosinophilic colitis (EC) is a rare entity characterized by abnormal infiltration of colon mucosa by eosinophils without evidence of any secondary causes. Presentation may include asymptomatic state, chronic diarrhea, abdominal pain, rectal bleed, bowel obstruction or ascites. We present two cases of EC with very different presentations requiring minimal or no therapy. CASE DESCRIPTION/METHODS: CASE 1: 57 year old Filipino male presented with abdominal pain and new onset ascites. Paracentesis revealed elevated SAAG suggestive of portal hypertension. Imaging studies were negative for cirrhosis. Negative liver workup for chronic liver disease. Lab studies revealed microcytic anemia and peripheral eosinophilia of 10%. No eosinophilia noted in ascitic fluid. EGD showed LA Grade C esophagitis. Colonoscopy showed multiple polyps which were removed. Pathology from polyps showed markedly increased eosinophil infiltrate in mucosa and submucosa. There was no evidence of inflammatory bowel disease, Stool studies were negative for infectious etiology. No incriminating medications were found which could lead to above finding. The patient was treated with omeprazole and diuretics with complete resolution of symptoms. CASE 2: 27 year old female presented with chronic intermittent abdominal pain, nausea and diarrhea for 2 years. Her only medications were birth control pills. She had normal blood counts, electrolytes, liver, and renal function. Stool studies were negative for any infectious etiology. She had normal fecal fat and electrolytes. EGD and colonoscopy were unremarkable. Biopsies were negative for celiac disease, Helicobacter and eosinophilic esophagitis. Random colon biopsies showed benign colon mucosa with focal infiltration of colonic mucosa with eosinophils suggestive of eosinophilic colitis. There was no peripheral eosinophilia. Patient was started on probiotics with prompt resolution of symptoms. DISCUSSION: EC is a rare condition, included in the group of eosinophilic gastrointestinal disorders, characterized by eosinophil infiltration of colonic mucosa in the absence of any food allergies, parasitic/helminthic infections, drugs, IBD, celiac and autoimmune diseases. The treatment options include dietary modifications, steroids, mesalamine, immunomodulatory agents, fecal microbiota transplant and surgery. The evidence for most of treatment options is limited to case reports. One of our patients required no specific therapy while other one was treated successfully with probiotics.

Introduction: Eosinophilic colitis (EC) is a rare inflammatory gastrointestinal disorder with a poorly understood pathophysiology. Recent studies suggest that eosinophil-driven breakdown of colonic wall structure may be contributing to both EC and early stages of inflammatory bowel disease (IBD). We report a case of a young woman with biopsy findings suggestive of both EC and ulcerative colitis (UC) in an early disease state. Case description/methods: An 18 year old female with a history of irritable bowel syndrome (IBS) for 2 years, obesity (BMI 31), depression, anxiety, migraines and ovarian cysts presents for outpatient colonoscopy for suspected ulcerative colitis after 3 months of diarrhea, vomiting, diffuse abdominal pain, chills and body aches. A CT abdomen showed a 12mm left ovarian cyst and no other discernible pathology. Her medications include bupropion, escitalopram, hydroxyzine, Depo-Provera, dicyclomine, and mesalamine rectal enema. She denies toxic habits and her vital signs were unremarkable. Her CMP, CBC and coagulation panels were also unremarkable, and COVID testing was negative. Her colonoscopy showed diffuse mild inflammation extending from the rectum to the descending colon suggestive of left-sided ulcerative colitis. Biopsies were taken from the right colon, left colon and terminal ileum. Pathology report showed mild active colitis with moderate eosinophilia in the right colon with at least 50 eosinophils per high power field (HPF), with similar findings in the left colon. The eosinophilia extended into the lamina propria with focal epithelial invasion of eosinophils, but no overt distortion of crypts or other signs of chronic colitis were noted. The terminal ileum showed no diagnostic pathology. Overall, the findings suggest a combination of early ulcerative colitis with eosinophilic colitis. Discussion: First described in the mid-19th century, eosinophils are continuously active in mucus and antibody secretion and should populate colonic mucosa in counts no higher than 50 per high power field. In contrast to EC, UC is characterized by mucosal infiltration by neutrophils helped in part by eosinophilic secretion of chemokines. Although our patient demonstrates left-sided colitis, histology did not show characteristic crypt abscesses nor neutrophilic invasion, but rather an eosinophilic predominance with a relatively mild phenotype. In light of current pathophysiologic literature, this may represent an early stage of UC development, or a mixed EC/UC phenotype rarely observed otherwise. (Figure Presented).

Objective To investigate the imaging features of surgical complications of Crohn′s disease (CD). Methods The retrospective cross-sectional study was conducted. The clinical data of 128 CD patients with surgical complications who were admitted to the Sixth Affiliated Hospital of Sun Yat-sen University from January 2014 to December 2015 were collected. All the patients underwent computed tomography enterography (CTE), magnetic resonance enterography (MRE), magnetic resonance imaging (MRI) of anal tube and X-ray examination. The patients underwent surgical therapies after examinations. Observation indicators: (1) clinical characteristics of surgical complications of CD: occurrence of surgical complications of CD, correlation between preoperative complications and Montreal types of CD, (2) diagnostic accuracy of surgical complications and perianal lesions through CTE, MRE and MRI of anal tube, (3) imaging findings of preoperative complications of CD, (4) treatment and follow-up situations. Follow-up using telephone interview and outpatient examination was performed to detect the postoperative recovery and reoperations of patients up to March 2016. Count data were represented as frequency or percentage. The correlation between preoperative complications and Montreal types of CD was represented as the odds ratio (OR) and 95% confidence interval (CI). The features of diagnostic indexes were described as the sensitivity and specificity. Results (1) Clinical characteristics of preoperative complications of CD: all the 128 patients had preoperative complications, including 71 with anal fistula or anal fistula combined with perianal abscess, 26 with intestinal fistula, 24 with intestinal obstruction, 23 with abdominal abscess, 3 with digestive tract perforation, 1 with kidney stone and 1 with hydronephrosis. Of 128 patients, 12 had intestinal fistula combined with abdominal abscess, 1 had intestinal fistula combined with intestinal obstruction, 3 had intestinal fistula combined with abdominal abscess and intestinal obstruction, 1 had intestinal fistula combined with digestive tract perforation and 1 had intestinal fistula combined with hydronephrosis. There was a correlation between lesion location of CD and type of complications. Thirty-five of 51 patients had strictures or penetration-type lesions, with a correlation between strictures or penetration-type lesions and ileal CD [OR=6.23, 95% confidence interval (95%CI) : 2.86-13.61, P<0.05]. Fifty-six of 77 patients had anal fistula, showing a correlation between combined anal fistula and colonic lesions of CD (OR=6.40, 95%CI: 2.92-14.01, P<0.05). (2) Diagnostic accuracy of CTE, MRE and MRI of anal tube: with intraoperative exploration findings as the standard, the sensitivity and specificity of surgical complications of CD were 84% and 95% through CTE or MRE, and the sensitivity and specificity of anal fistula were 100% and 100% through MRI of anal tube. (3) Imaging findings of surgical complications of CD. ① Of 71 patients with anal fistula, 65 had 2 or more internal openings or fistula tract of complex anal fistula. The internal opening was a starting point of the fistula tract, and enhanced scans of MRI displayed punctate, shredded or small round abnormal strengthening signals between under mucous membrane of the anal canal and sphincter. The tubular and striped fistula tract was horizontal or vertical distribution, with a lightly high-high signal on T2 weighted-images (WI). The results of enhanced scans of MRI showed that there was an obvious homogeneous enhancement in the fistula tract or enhancement in the fistula tract wall, and no enhancement in the cavity of fistula tract. MRI findings in 38 patients combined with perianal abscess included a obvious high-signal on T2WI, and enhanced scans of MRI showed circular enhancement and no internal enhancement. ② Of 26 patients with intestinal fistula, 17 had intestinal fistula, imaging findings included multiple thickened intestinal walls and more obvious enhancement compared with normal intestinal canal. There was gathering and adhesions among intestinal canals, showing mash connections and petal-like changes. Fourteen patients had enterocutaneous fistula (6 combined with intestinal fistula and 1 patient combined with intestinal fistula and intestine-bladder fistula). Four patients had intestine-bladder fistula (2 combined with intestinal fistula and 1 combined with intestinal fistula and enterocutaneous fistula). One patient had intestine-vagina fistula. The results of CTE and MRE examinations showed that thickened intestinal canals and intestinal walls in the lesions, and shadows of intestinal canals communicated with the abdominal, bladder wall and vagina, with a high signal on T2WI and enhancement of intestinal wall by enhanced scan. The partial intestinal canals were physically close to other organs, without a connection between them, and anomalous enhancement or local pneumatosis among the adjacent organs were detected. ③ CTE findings of intestinal obstruction included constriction of intestinal canal combined with dilatation of proximal intestinal canal. There were 3 enhancement methods of thickened intestinal wall in 24 patients with intestine obstruction. Imaging findings of 12 patients included enhancement in the intestinal mucosa and no enhancement in the submucosa and muscularis mucosa. Imaging findings of 4 patients included enhancement of intestinal mucosa and muscularis mucosa and no enhancement in the submucosa. Imaging findings of 8 patients included homogenous and heterogeneous enhancements in the intestinal walls. ④ Twenty-three patients were complicated with abdominal abscess, including 15 combined with intestine fistula. The scans of CTE showed that there was a round-like or oval mass in the abdomen, with a high signal on T2WI, fluid-dominated inflammatory exudation around the mesentery, the enhancement of annular wall of mesentery and no enhancement of pus within the mesentery. ⑤ Three patients were combined with digestive tract perforation, including 1 combined with intestine fistula. CTE and X-ray detections showed there was a shadow of free gas in the intestinal mesentery and under abdominal diaphragm. ⑥ Two patients were combined with kidney stone and hydronephrosis. X-ray findings of kidney stone included the deposition of multiple and sharp-edged dense shadows within the renal calices. CTE findings of hydronephrosis included inflammatory thickening of ureteric wall with proximal ureter dilatation. (4) Treatment and follow-up situations: 128 patients underwent successful operation and were followed up for 4-27 months. Of 10 patients undergoing reoperations due to postoperative complications, MRI detection of 7 patients with recurrence of anal fistula showed fistula tract or abscess located at the previous loci was incompletely healed or progressed, morphous and location of lesions were roughly the same as the preoperative situations. The scans of CTE in 2 patients with anastomotic stricture showed that there were the thickening of intestinal wall and obstruction and dilatation at the proximal anastomotic-site. The enhanced scan of CTE in 1 patient with anastomotic fistula showed that there were irregularly cavity-like lesion beside the metal anastomotic ring, and effusion was seen within the lesions, with an edge enhancement. The other 118 patients recovered well without intestinal fistula or intestinal obstruction on CTE or MRE examination. Conclusions Anal fistula is the most common surgical complication of CD, and intestinal fistula, intestinal obstruction and abdominal abscess are also relatively common. The early postoperative complications consist of the recurrence of anal fistula. Location of lesions in CD is associated with the type of complications. CTE or MRE and anal MRI findings have different imaging characteristics for CD combined with different complications, with a certain value in the assessment of abdominal and perianal complications. Key words: Crohn′s disease; Surgical complications; Tomography, X-ray computed; Magnetic resonance imaging

Eosinophilic colitis (EC) is the rarest among primary eosinophilic gastrointestinal disorders (EGID). EC is underdiagnosed due to its blurred and proteiform clinical manifestations. To explore the clinical and atopic characteristic of EC adult patients, the diagnostic delay, and relapse-associated factors, by comparison with patients with eosinophilic esophagitis (EoE) and irritable bowel syndrome (IBS). EC patients followed-up at four clinics were included, and clinical, histopathological, and laboratory data were retrieved. As control groups, age-matched patients with EoE and IBS were recruited. Allergy tests included skin prick test and serum specific IgE. Diagnostic delay was assessed. Overall, data from 73 patients were retrieved, including 40 with EC (median age 39 years IQR 22.5–59, F:M 2.1:1), 12 with EoE (F:M ratio: 1:5), and 21 with IBS (F:M ratio: 1:0.9). The most common features in EC patients were female sex (67.5%), atopy (77.5%), abdominal pain/distention (70%), diarrhoea (77.5%), and faecal calprotectin elevation (22.5%). Blood eosinophils were elevated in EoE, but not in EC (p < 0.001), while ECP did not differ across the three groups (p = 0.4). The frequency of allergen sensitization reached 25% of patients. Several frequent pan-allergens for this region were present. The overall diagnostic delay was 10 months (IQR 4–15). Factors contributing to a greater diagnostic delay were atopy, weight loss, and a previous misdiagnosis. EC is mostly a diagnosis of exclusion, burdened by a substantial diagnostic delay. In female patients the presence of allergen sensitization, abdominal symptoms and faecal calprotectin elevation should raise the suspicion of EC.

Introduction: Eosinophilic colitis (EC) is a common problem in infancy. Cow’s milk protein intolerance has been identified as the main causative agent. It responds well to cow’s milk exclusion and most children grow out of it by school age. There is however little known about EC presenting after infancy. The aim of this study was to assess the presentation, histological diagnosis and response to treatment in children with EC presenting after infancy. Methods: From all patient with colitis diagnosed between 1995 and 1996,12 patients over 1 year old with EC(group 1)were identified and compared to 5 patient under 1 year with EC(group 2).Both groups were retrospectively studied. Group 1 patients (8 Male,4 Female, median age at presentation 5 years, range from 1.8 – 14.2 years)were followed up for a median of 7.1 years (range 5.3–8.9 years). All group 2 patients (3 male, 2 female, median age 0.3 years range from 0.1–0.8 years) were followed for a median of 3.1 years (range 1.8–4.2 years). Symptoms at presentation, personal and family history of atopy and immunology tests were evaluated. Histology was reviewed by an independent histopathologist who was blinded to the clinical symptoms and outcome. Eosinophilc subepithelial infiltration, degranulation and crypt penetration was graded. Response to diet, medical treatment and overall outcome were evaluated. Results: Initial presentation of group 1 patients was with abdominal pain 8/12, diarrhoea 7/12 and bleeding per rectum 6/12. All group 2 patients presented with rectal bleeding. IgG,A,M,E and specific IgE antibodies were similar in both groups. In both groups a mixed infiltrate with both sub-epithelial and and pericryptal eosinophilia was the commonest finding while 1/12 had a pericryptal eosinophilic infiltrate only and 4/12 had a sub-epithelial eosinophilic infiltrate. There was no correlation between presentation, outcome and the site of infiltrate. 4/5 patients from group 2 compared to 1/12 patient from group 1 improved on diet exclusional one (P = 0.0 04). 9/1 2 patients needed 5-aminosalicylates, 4/12 steroids and 2/12 azathioprine. 5/12 patients were asymptomatic on diet and treatment, 3/12 were off diet and treatment, while 2 were well on diet alone. Conclusion: EC may be more common in children after infancy than usually suspected. Presentation and response to diet are different in children presenting during and after infancy. EC after infancy can run a prolonged course and may need immunosuppressive treatment. Grading the distribution of the eosinophils within the colonic mucosa may be a helpful tool in understanding the nature of the infiltrate and a guide to subsequent treatment. Since the number of subjects studied is small a larger study is required to clarify these patients.

Refeeding fasted rats with normal rat food and with a variety of amino acids increases ornithine decarboxylase (ODC) activity considerably. The time course of that increase, the areas of the digestive tract directly affected, and the effective concentrations of stimulants are unknown. By use of isolated 5-cm segments of rat jejunum, we determined that maximal activation of ODC occurred after a 2-h exposure to 0.6 M glycine. Increased activity was first apparent after a 1-h exposure to glycine and was significant after a 2-h exposure to 0.05 M glycine. ODC activity increased the most in segments of jejunum, followed by segments of ileum and then duodenum. Glycine (0.4 M) failed to increase ODC activity in gastric and colonic mucosa. Interestingly, D-alanine was more effective than L-alanine in stimulating ODC activity in the jejunum. Enzyme activity was not dependent on osmotic activity of the test substances. Glucose increased enzyme activity, but mannitol and fructose were without effect. The effects of glycine were significantly greater than those of glucose. In summary, ODC of the small intestinal mucosa is increased by direct contact with amino acids and glucose within 2 h after exposure. Increased enzyme activity depends on the nature of the stimulant rather than the osmotic activity of the solution in contact with the mucosa.

BACKGROUND Eosinophilic colitis (EoC) is a rare gastrointestinal inflammation of the colon due to an altered hypersensitivity reaction characterized by eosinophilic infiltration into the colonic wall. Patients usually present with abdominal pain, diarrhea, and weight loss. METHODS We used the National Inpatient Sample (NIS) database to conduct a retrospective study of hospitalized adult patients with eosinophilic colitis using the validated ICD-10 diagnosis codes between January 1, 2016, and December 31, 2020. RESULTS We identified 4353 cases of eosinophilic colitis using the NIS database. There were 748, 776, 889, 934, and 1,006 eosinophilic colitis cases diagnosed in 2016, 2017, 2018, 2019, and 2020 respectively. Males were more likely to be hospitalized due to eosinophilic colitis than females (51.8% vs. 48.2%). Moreover, there was a significantly higher prevalence of eosinophilic colitis among the white population, with 81.7% in Whites, 8.1% in Blacks, 6.3% in Hispanics, and 1.3% in Asians. 26.5% of those patients had Medicare, 15.7% had Medicaid, and 50.6% had private/HMO insurance. About 20.7% of patients had a median household income of $45,999 or less, 23.6% had $46,000-58,999, and 55.6% had $59,000 or more. Based on hospital location, 30.3% of the cases were in the South, 27.5% in the Midwest, 23.4% in the West, and 18.8% in the Northeast. The majority of patients admitted for eosinophilic colitis were recorded in urban teaching hospitals (77.8%) compared to 17.6% in urban nonteaching hospitals and 4.6% in rural areas. Only 16.5% of the patients with eosinophilic colitis had a Charlson Comorbidity Index of 3 or higher. CONCLUSION Based on the national inpatient sample over 5 years, males and whites are more likely to be hospitalized with eosinophilic. The report suggests that eosinophilic colitis is common among patients with high median household income and has a better prognosis.

Introduction: Eosinophilic colitis (EoC) is a rare entity characterized by the presence of high eosinophilic infiltrate into the colonic wall in symptomatic patients, in the absence of known other causes of colonic eosinophilia. Recently proposed guidelines suggest 100 eosinophils per high-power-field in the ascending colon, 85 in the descending, and 65 in the sigmoid colon as diagnostic thresholds. Whereas ulcerative colitis (UC), is known to be associated with an increased risk of colorectal cancer (CRC), little is known of the association between EoC and CRC. We aimed to compare EoC patients to UC patients to assess their odds of developing CRC. Methods: Using the multi-institutional, health research network database TriNetX (Cambridge, MA), de-identified, aggregated clinical data were obtained on patients with a diagnosis of either EoC or UC. Patients with other identifiable causes of eosinophilia were excluded from the EoC cohort, including inflammatory bowel disease, food allergies, helminth infections, and other eosinophilic gastrointestinal disorders. A 1:1 propensity score matching method was used to stratify EoC and UC patients. Matched variables were age at diagnosis, sex, race, obesity, tobacco abuse, alcohol abuse, and family history of digestive tract malignancy. Odds ratios(OR) and confidence intervals (CI) were calculated for development of CRC and subsequent colonoscopies for each cohort. Results: A total of 1,310 and 195,477 EoC and UC patients were identified, respectively (Table). The higher proportion of EoC patients were female compared to UC patients (65.4% vs 54.4%), and were African American (11.9% vs 9.2%). More EoC patients reported tobacco usage (4.6% vs 2.5%) and were obese (11.8% vs 7.0%) compared to UC patients. A 1:1 matching ratio stratified 1,310 patients into each cohort. After adjusting for the aforementioned covariates, EoC patients had an OR of 1.304 (95% CI 0.828-2.054, p-value 0.2503) of developing CRC compared to UC patients (Figure). EoC patients demonstrated an OR of 0.754 (95% CI 0.583-0.976, p-value 0.0313) of undergoing subsequent surveillance colonoscopies after initial diagnosis of disease compared to UC patients. Conclusion: Patients with a diagnosis of EoC have a similar risk of developing colorectal cancer compared to UC patients. Despite this, EoC patients are less likely to undergo subsequent surveillance colonoscopy compared to UC patients. Hopefully, our data can be used for future prospective studies investigating the natural course of EoC.Figure 1.: Forest plot showing odds ratios and confidence intervals of development of colorectal cancer (CRC) and subsequent surveillance colonoscopies in EoC patients compared to UC patients Table 1. - Baseline patient characteristics of EoC (eosinophilic colitis) and UC (ulcerative colitis) patients before and after 1:1 propensity score matching Baseline Patient Characteristics Before Matching p-value After Matching p-value EoC(n=1,310) UC(n=195,477) EoC(n=1,310) UC=n1,310) Age at Diagnosis 54 +/- 17.2 51 +/- 17.6 < 0.0001 54 +/- 17.2 54 +/- 17.4 0.9451 Sex Female 857(65.4%) 106,402(54.4%) < 0.0001 857(65.4%) 865(66.1%) 0.7419 Male 453(34.6%) 89,075(45.6%) < 0.0001 453(34.6%) 445(33.9%) 0.7418 Race African American 157(11.9%) 17,934(9.2%) 0.0005 157(11.9%) 134(10.2%) 0.1527 Asian 32(2.4%) 3,583(1.8%) 0.1014 32(2.4%) 39(2.9%) 0.3997 Caucasian 980(74.8%) 145,147(74.3%) 0.6468 980(74.8%) 1,007(76.9%) 0.2178 Other/Unknown 141(10.9%) 28,813(14.7%) < 0.0001 141(10.9%) 130(10.0%) 0.6152 Other Covariates Alcohol abuse 18(1.4%) 3,241(1.7%) < 0.0001 18(1.4%) 151(11.5%) 0.8078 Family history of GI cancer 38(2.9%) 4,033(2.1%) < 0.0001 38(2.9%) 49(3.7%) 0.2818 Obesity 155(11.8%) 13,688(7.0%) 0.4222 155(11.8%) 12(0.9%) 0.2706 Tobacco use 60(4.6%) 4,807(2.5%). 0.0338 60(4.6%) 31(2.4%) 0.3931

A 39-year-old man presented with diarrhea and abdominal pain. At 26 years of age, he was found to have eosinophilia and abnormal liver function parameters, for which prednisolone therapy was started. He subsequently underwent a liver biopsy and endoscopic retrograde cholangiopancreatography, and received a diagnosis of primary sclerosing cholangitis (PSC). On presentation to our hospital, he was further diagnosed with eosinophilic colitis based on aggravation of diarrhea and severe eosinophilic infiltration in the colonic mucosa. We herein report a rare case of concurrent PSC and eosinophilic colitis.

Crohn's disease (granulomatous enteritis, granulomatous colitis, terminal ileitis) is a chronic relapsing disease characterized by transmural granulomatous inflammation with segmental lesions often of the small and large intestine. Eosinophilic colitis is a rare disease characterized by high level of eosinophilic infiltrate in the colon wall in patients with symptoms, more often manifested by abdominal pain or diarrhea. We face more often with the unique combination of these two diseases, characterized by different types of immunological reactions. We presented the clinical case of Crohn's disease and eosinophilic colitis in a 15-year-old boy. We face more often with the unique combination of these two pathological conditions, characterized by different types of immunological reactions, The article presents the clinical case of Crohn's disease and eosinophilic colitis in a 15-year-old boy. The aim of this clinical case is to increase the knowledge of practitioners about inflammatory bowel diseases, to point out possible combinations of different immunological inflammatory reactions in one patient, and the difficulties in diagnosing and managing this kind of patients. Key words: Crohn's disease, eosinophilic colitis, diagnosis, treatment, hormone-resistant form, targeted therapy, children

Among the Inflammatory Bowel Diseases in horses, eosinophilic and lymphoplasmacytic enteritis is rare and is characterized by an infiltrate of inflammatory cells, causing problems with nutrient absorption, diffuse neoformation and changes in the histological structure of all the tissue layers of the intestine. This report describes a case of eosinophilic and lymphoplasmacytic colitis in an 11-year-old male horse with progressive weight loss, sings of colic syndrome and apathy. No alterations were found in the blood Count, except for leukocytosis with neutrophilia. The biochemical examination showed an increase in indirect bilirubin, and the peritoneal fluid showed a high concentration of total protein, lactate and total nucleated cells. Ultrasound identified free fluid in the abdominal cavity and neoformation in the colon. In view of the findings, exploratory celiotomy was recommended; however, euthanasia was chosen considering the cost-benefit and zootechnical value of the animal. Post-mortem histopathological examination of fragments of the greater and lesser colon identified Lymphoplasmacytic colitis and eosinophilic colitis, chronic process, with no determined cause and treatment that is not always effective, but preventive health management measures minimize the triggering factors.