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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.

Liver Transplantation and Surgery : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

|December 24, 1997

Summary

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.

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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.

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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.