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Author Spotlight: Investigating the Pathophysiology of Eosinophilic Esophagitis
Published on: May 10, 2024
Eosinophilic duodenitis misdiagnosed as acute pancreatitis in a child: a case report
Jia-Ke Yu1, Yi Chen1, Hai Cao1
1Department of Pediatrics, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing312000, China.
Insights
Pediatric eosinophilic duodenitis, a rare gastrointestinal disorder, can mimic acute pancreatitis. Early diagnosis and treatment with steroids lead to symptom resolution and prevent recurrence.
Area of Science:
- Gastroenterology
- Pediatrics
- Immunology
Background:
- Eosinophilic Gastrointestinal Disorders beyond Eosinophilic Esophagitis (non-EoE EGIDs) are rare chronic inflammatory conditions.
- These disorders involve eosinophilic infiltration of the gastrointestinal tract.
Observation:
- A 13-year-old girl presented with symptoms mimicking acute pancreatitis, including abdominal distension, vomiting, and epigastric pain.
- Initial diagnosis was acute pancreatitis based on elevated amylase/lipase and imaging, but eosinophilia worsened.
- Esophagogastroduodenoscopy revealed eosinophilic duodenitis.
Findings:
- Histopathological examination confirmed eosinophilic duodenitis.
- The patient was successfully treated with oral prednisone, with symptoms resolving.
- A 1-year follow-up showed no recurrence.
Implications:
- Non-EoE EGIDs should be considered in pediatric differential diagnoses for unexplained eosinophilia and duodenal abnormalities.
- Prompt diagnosis and management of eosinophilic duodenitis are crucial for favorable outcomes.
Background:
Eosinophilic Gastrointestinal Disorders beyond Eosinophilic Esophagitis (non-EoE EGIDs) are chronic rare inflammatory disorders characterized by eosinophilic infiltration of the gastrointestinal (GI) tract.
Case Presentation:
We report the first pediatric case of eosinophilic duodenitis (one type of the non-EoE EGIDs) with concomitant pancreatic reaction that was misdiagnosed as acute pancreatitis (AP). A 13-year-old girl was admitted to our hospital for a week of abdominal distension, vomiting, and epigastric pain that worsened recently. She was suspected of AP based on increased amylase and lipase values and relevant imaging findings. During hospitalization, her clinical manifestation improved, while the eosinophilia was more aggravated without a known cause. Esophagogastroduodenoscopy (EGD) was performed, and histopathological evidence demonstrated the diagnosis of Eosinophilic duodenitis, which was treated with oral prednisone tapering. During the 1-year follow-up, the patient was symptom-free and presented no signs of recurrence.
Conclusions:
Although rare, pediatricians should consider non-EoE EGIDs in the differential diagnosis in children presenting with peripheral blood eosinophilia and duodenal wall thickening on imaging findings.
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