Eosinophilic gastroenteritis with hemorrhagic ascites: a case report

Area of Science:

• Gastroenterology
• Pediatric Medicine
• Immunology

Background:

• Eosinophilic gastroenteritis (EGE) is a rare inflammatory condition marked by increased eosinophils in the gastrointestinal tract.
• Clinical presentations of EGE, particularly with hemorrhagic ascites, are exceptionally uncommon, increasing the likelihood of misdiagnosis.
• Pediatric cases of EGE with unusual symptoms like abdominal pain, tonsillitis, and mesenteric lymphadenitis can be mistaken for infections.

Observation:

• A pediatric patient presented with severe, paroxysmal abdominal pain, acute tonsillitis, and mesenteric lymphadenitis, initially suggestive of an intestinal infection.
• Diagnostic workup included ultrasound, CT scans, ascites analysis, bone marrow examination, and gastroscopy with biopsy.
• Initial antibiotic treatment (Ceftriaxone Sodium) was ineffective, and ascites worsened, prompting further investigation.

Findings:

• The patient was diagnosed with Eosinophilic Gastroenteritis (EGE) based on comprehensive diagnostic evaluations.
• Histopathological examination confirmed the eosinophilic infiltration characteristic of EGE.
• The diagnosis was complicated by the co-occurrence of hemorrhagic ascites, a rare manifestation.

Implications:

• This case underscores the importance of considering EGE in pediatric patients with unexplained abdominal pain and ascites, even with signs mimicking infection.
• Effective management involved transitioning from antibiotics to anti-inflammatory and anti-allergic therapies, including prednisone, Singulair, and cetirizine.
• Accurate and timely diagnosis of EGE is crucial to prevent complications and guide appropriate treatment strategies.