University of Connecticut Health Center Farmington, CT, United States
Leen Z. Hasan, MD1, Eric Vecchio, MD2, Qian Wu, MD, MSc1, Steven Goldenberg, MD1, Houman Rezaizadeh, MD1 1University of Connecticut Health Center, Farmington, CT; 2University of Connecticut, Farmington, CT
Introduction: The prevalence of eosinophilic gastrointestinal disorders (EGID), particularly eosinophilic esophagitis (EoE), increased significantly since they were first described. In this case report, we present a patient with EoE with subsequent diagnosis and response of eosinophilic colitis (EC) to systemic corticosteroids and emphasize the importance of keeping a high index of suspicion for involvement of other segments of the gastrointestinal tract in those with refractory symptoms.
Case Description/Methods: A 33-year-old male with a history of asthma and allergic rhinitis was diagnosed with EoE at the age of 28 when he presented with esophageal dysphagia and reflux symptoms resistant to proton-pump inhibitor therapy (PPI); esophagogastroduodenoscopy (EGD) demonstrated ringed esophagus with two dominant rings and tissue biopsy revealed > 50 eosinophils per high-power field (hpf) consistent with EoE. Several treatments were tried, including a topical and swallowed fluticasone in combination of dexlansoprazole and intermittent 4-food elimination diet, resulting in only partial relief. He underwent repeated EGDs 2-3 times per year for dilatations; however, he experienced persistent dysphagia and reflux, requiring Heimlich maneuver at times for sensation of choking. A more thorough evaluation subsequently revealed history of chronic diarrhea and abdominal cramping raising the suspicion for eosinophilic gastroenteritis/colitis (EGE/EC). Therefore, a repeat EGD along with a colonoscopy was performed with samples from the esophagus revealing >80 eosinophils/hpf consistent with EoE. Samples from the ascending colon demonstrated eosinophils in the lamina propria and epithelium with >100 eosinophils/hpf (figure 1). As a result, he was diagnosed with EC. Shortly after the diagnosis, the patient received a 10-day course of oral steroids for SARS-CoV-2 pneumonia which ultimately relieved his prior GI symptoms of diarrhea and abdominal pain further supporting this diagnosis.
Discussion: Patients with EoE and new or persistent GI symptoms require a high index of suspicion for involvement of distal segments of the GI tract. EGE and EC remain rare entities, and their diagnosis and management can be challenging given the non-specific manifestations and varied treatment responses. Symptoms refractory to initial therapies should raise suspicion for involvement of other segments of the gastrointestinal tract, which often require more aggressive therapies, such as systemic corticosteroids.
Figure: Figure 1: Histopathological appearance of ascending colon in a patient with Eosinophilic Colitis. Colonic mucosa with prominent eosinophils (>100 per high power field) in the lamina propria and scattered intraepithelial eosinophils (arrows)
Leen Hasan indicated no relevant financial relationships.
Eric Vecchio indicated no relevant financial relationships.
Qian Wu indicated no relevant financial relationships.
Steven Goldenberg indicated no relevant financial relationships.
Houman Rezaizadeh indicated no relevant financial relationships.
Leen Z. Hasan, MD1, Eric Vecchio, MD2, Qian Wu, MD, MSc1, Steven Goldenberg, MD1, Houman Rezaizadeh, MD1. P1227 - Eosinophilic Esophagitis With Subsequent Eosinophilic Colitis: Keeping a High Index of Suspicion, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.