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Posttransplant eosinophilic gastroenteritis in children
A Dhawan1, T A Seemayer, C Pinsinski
1Department of Pediatrics, University of Nebraska Medical Center, Center for Human Nutrition, Omaha 68198-5160, USA.
Insights
Eosinophilic gastroenteropathy in children post-liver transplant may be linked to high-dose corticosteroid pulses. Symptoms resolved when corticosteroid doses were tapered, suggesting a potential treatment strategy.
Area of Science:
- Gastroenterology
- Immunology
- Pediatric Medicine
Background:
- The etiology of eosinophilic gastroenteropathy in children and adults remains largely unknown.
- Post-liver transplantation patients often receive immunosuppressive therapy, including corticosteroids and calcineurin inhibitors like cyclosporine A.
Observation:
- Two pediatric liver transplant recipients developed intestinal symptoms weeks after receiving a single, high-dose bolus of corticosteroids without a tapering schedule.
- These patients were concurrently on low-dose cyclosporine A and alternate-day prednisone.
Findings:
- Histological examination of gastrointestinal mucosal biopsies revealed intense eosinophilic infiltration of the mucosa and lamina propria in both patients.
- Intestinal symptomatology resolved following a gradual taper of corticosteroid administration.
Implications:
- This case series suggests a potential association between high-dose corticosteroid pulses and eosinophilic gastroenteropathy in pediatric liver transplant patients.
- Clinicians should consider post-transplant gastroenteric eosinophilic inflammation in patients on immunomodulatory drugs presenting with chronic intestinal symptoms.
Abstract:
The cause of eosinophilic gastroenteropathy in older children and adults is unknown. In this report, two post-liver transplantation children treated with low-dose cyclosporine A and alternate-day low-dose prednisone are described who were administered a single bolus administration of a lympholytic dose of corticosteroids without taper and who developed intestinal symptomatology several weeks later. Histologic examination of mucosal biopsy specimens from various regions of the gastrointestinal tract showed an intense eosinophilic infiltration of the mucosa and lamina propria. The patients recovered after corticosteroid administration was tapered. Post-transplant gastroenteric eosinophilic inflammation may need to be considered in patients on immunomodulatory medications who have chronic intestinal symptomatology.