[Severe eosinophilia in a patient with clostridium colitis and gastric cancer]

A case of a 77-year-old male repeatedly hospitalized with the diagnosis of Clostridium difficile colitis associated with eosinophilia is presented. The percentage and number of eosinophils achieved maximal values (54 %, 5.4 times 1.000.000.000/l) during repeated treatment with metronidazole. Eosinophilia was accompanied by significant elevation of serum IgE and presence of Charcot-Leyden crystals in stool. Helminth infections and hemoblastosis were ruled out as the cause and a working diagnosis of eosinophilic gastroenterocolitis induced by antibiotics was established. The working diagnosis was supported by a decrease in eosinophils observed after a switch from metronidazole to vancomycin. After one month, the patient was hospitalized with gastrectasia, for which gastric biopsy was performed with a finding of infiltrating carcinoma. A differential diagnostic approach to patients with eosinophilia is discussed and the need for ruling out relatively rare causes such as tumors is stressed.