Eosinophilic ascites: a diagnostic challenge

Area of Science:

• Gastroenterology
• Internal Medicine
• Allergy and Immunology

Background:

• Eosinophilic gastroenteritis is a rare condition characterized by eosinophilic infiltration of the gastrointestinal tract.
• Eosinophilic ascites is an uncommon but increasingly recognized complication, often presenting with unexplained abdominal distension.

Observation:

• A 25-year-old woman presented with severe gastrointestinal symptoms, including nausea, vomiting, diarrhea, and abdominal pain, following childbirth.
• She experienced postprandial itching and a generalized urticarial rash, with a history of atopy.
• Physical examination revealed abdominal tenderness and distension, with peripheral eosinophilia and moderate ascites confirmed by imaging.

Findings:

• Diagnostic paracentesis demonstrated exudative ascites with a significant number of eosinophils.
• Histological examination of the gastrointestinal tract confirmed eosinophilic infiltration of the mucosa.
• The patient showed marked clinical improvement after treatment with corticosteroids and a six-food elimination diet.

Implications:

• This case highlights the importance of considering eosinophilic ascites in the differential diagnosis of unexplained ascites, particularly in patients with a history of atopy.
• Early recognition and appropriate management, including dietary modifications and anti-inflammatory therapy, can lead to significant symptom improvement.
• Further research into the pathogenesis and optimal management of eosinophilic gastroenteritis with ascites is warranted.