Eosinophilic Ascites: An Infrequent Presentation of Eosinophilic Gastroenteritis

Eosinophilic gastroenteritis (EGE) is an unusual and benign inflammatory disorder that mainly affects the digestive tract. Its main symptoms are cramp-like abdominal pain, nausea, vomiting, diarrhea, gastrointestinal bleeding, and weight loss. Laboratory results show peripheral eosinophilia. This disease generally affects patients with a personal history of atopy and drug or food intolerance. The etiology remains unknown, the diagnosis is challenging, and the treatment depends on the severity of the disease and can range from supportive therapy to corticosteroid therapy. We report a case of a 24-year-old female known to have a history of iron deficiency anemia who was brought to the emergency department with an intense colicky abdominal pain, fatigue, diarrhea, and vomit right after a mild coronavirus disease 2019 (COVID-19) infection. The clinical investigation revealed moderate ascites identified in abdominal computed tomography (CT) scan, peripheral blood eosinophil count, and elevation of inflammatory parameters. An ultrasound-guided diagnostic paracentesis was performed, showing ascitic fluid with a clear predominance of eosinophils (57%). To confirm the diagnosis of EGE, an upper digestive endoscopy (UDE) was performed. The biopsies of the esophagus and gastric body revealed polymorphonuclear eosinophils and colonic mucosal biopsies revealed eosinophils (20 eosinophils per 10 fields). After reviewing the clinical history, we concluded that the patient was taking iron supplements due to her iron deficiency anemia, whose onset coincided with the symptoms presented. Exploring the clinical history a little more, the patient mentioned that in the past, she already had some intolerance to oral iron supplements, manifested by gastrointestinal symptoms, although milder. Approximately three weeks after suspending the supplements, we have seen an analytical improvement that was accompanied by clinical improvement. The patient was discharged with the resolution of abdominal pain.