Eosinophilic Esophagitis Revealed by Hematemesis in an Asthmatic Adolescent: A Case Report

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus, with increasing prevalence and incidence, characterized by eosinophilic infiltration of the mucosa, and frequently associated with asthma and atopic predisposition. We report the case of a 13-year-old female patient with poorly controlled moderate persistent asthma, admitted for recurrent vomiting over the past year, complicated by the sudden onset of hematemesis, associated with fever and clinical deterioration. On admission, the patient presented with tachycardia, hypoxemia, and acute respiratory distress associated with an asthma exacerbation. An emergency esophagogastroduodenoscopy revealed EoE, with histopathology demonstrating dense eosinophilic infiltration (>15 eosinophils/high-power field). Allergy testing revealed food sensitization to prawns. Treatment with oral fluticasone (250 μg twice daily) combined with double-dose proton pump inhibitors resulted in rapid clinical remission and complete histological normalization at 10 months. This case highlights the need to systematically consider EoE in the presence of any acute gastrointestinal symptoms in a patient with atopic predisposition, and the importance of early management.