A case of exuberant endoscopic presentation of asymptomatic eosinophilic colitis

Eosinophilic colitis is a rare entity characterized by a broad range of gastrointestinal symptoms and idiopathic infiltration of eosinophils in the colon. This condition is most likely underreported due to the absence of standardized diagnostic criteria. We present the case of a 72-year-old man who underwent an outpatient colorectal cancer surveillance colonoscopy without gastrointestinal complaints. Colonoscopy revealed a diffuse micronodular pattern of the colonic mucosa, with histopathological analysis showing a polymorphic infiltrate rich in eosinophils in the lamina propria. The patient was kept under surveillance, with a repeat colonoscopy showing persistent endoscopic and histological findings consistent with eosinophilic colitis. The patient remains asymptomatic. This case is unique from both clinical and endoscopic perspectives due to the asymptomatic course of this rare condition and the illustrative iconography.