Eosinophilic granulomatosis with polyangiitis and diffuse gastrointestinal involvement

Area of Science:

• Internal Medicine
• Gastroenterology
• Rheumatology

Background:

• Eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg-Strauss syndrome, is a rare systemic vasculitis.
• EGPA is defined by severe asthma, eosinophilia in blood and tissues, and small- to medium-sized vessel inflammation.
• Gastrointestinal (GI) symptoms are frequent in EGPA, but histological confirmation of GI involvement is uncommon.

Observation:

• A patient undergoing EGPA treatment experienced recurrent small bowel obstruction and choledocholithiasis.
• Diagnostic biopsies were taken from the esophagus, small bowel, and common bile duct.
• These biopsies revealed diffuse eosinophilic infiltration, confirming EGPA involvement in the GI tract.

Findings:

• Histological examination of GI tissues demonstrated significant eosinophilic infiltration.
• The findings confirmed EGPA affecting the esophagus, small intestine, and common bile duct.
• This provides rare histologic evidence of EGPA within the gastrointestinal system.

Implications:

• Increased clinical awareness of gastrointestinal EGPA is crucial for early detection.
• Timely diagnosis and management of GI EGPA can prevent severe complications.
• Recognizing GI manifestations improves patient outcomes in EGPA.