Abstract
This case reports the unique association of eosinophilic gastrointestinal disease with eosinophilic bronchitis, asthma and chronic rhinosinusitis and some features of lymphocytic hypereosinophilic syndrome, describes a diagnostic protocol for patients with asthma and persistent eosinophilic bronchitis, and suggests that the use of a novel EPX-mAb provides a reliable method to identify eosinophilic inflammation.
Highlights
Eosinophilic gastrointestinal disease (EGID) is characterized by identification of abnormal eosinophilic infiltration on morphologic evaluation of gastrointestinal tissues obtained by biopsy or resection from patients with gastrointestinal complaints [1]
We report the association of eosinophilic gastroenteritis and eosinophilic bronchitis in a young patient with prednisone-dependent asthma and some features of lymphocytic hypereosinophilic syndrome and the sensitivity of a novel monoclonal antibody directed against eosinophil peroxidase (EPX-mAb) [4] as an unambiguous means with which to detect both infiltrating tissue eosinophils and eosinophil degranulation in gastrointestinal tract biopsies
She declined treatment with interferon-alpha. She is currently on 35 mg daily prednisone in addition to fluticasone+salmeterol 500+50 mcg twice daily, awaiting approval for treatment with mepolizumab, a monoclonal antibody against interleukin 5 (IL-5) [6,7]. This clinical case provides an example of a unique association of eosinophilic gastroenteritis with eosinophilic bronchitis and asthma in the absence of atopy, vasculitis or classical hypereosinophilic syndrome
Summary
Eosinophilic gastrointestinal disease (EGID) is characterized by identification of abnormal eosinophilic infiltration on morphologic evaluation of gastrointestinal tissues obtained by biopsy or resection from patients with gastrointestinal complaints [1]. The diagnosis for eosinophilic esophagitis and other EGIDs is established after ruling out other causes of an eosinophilic disease, atopy, parasitic infestations, vasculitis, and hypereosinophilic syndrome (HES) [3]. We report the association of eosinophilic gastroenteritis and eosinophilic bronchitis in a young patient with prednisone-dependent asthma and some features of lymphocytic hypereosinophilic syndrome and the sensitivity of a novel monoclonal antibody directed against eosinophil peroxidase (EPX-mAb) [4] as an unambiguous means with which to detect both infiltrating tissue eosinophils and eosinophil degranulation in gastrointestinal tract biopsies.
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