Hyper-eosinophilic syndrome (HES) can be fatal if left untreated; and it is difficult to make a diagnosis early on due to the symptoms overlapping with many other conditions. For patients presenting with eosinophilia and end-organ damage, clinicians should have a high degree of suspicion for HES. Treatment with steroids can prevent further progression or can lead to complete resolution of the symptoms.

It is well known, based on the previous research, that a ketogenic diet leads to an improvement in the lipid profile and decreases cardiovascular risk factors such as hypertension. However, recent studies have also reported increased levels of total cholesterol and low-density lipoprotein cholesterol (LDL-C) as a result of this diet. It has been postulated that this elevation in LDL-C would not likely increase cardiovascular complications due to the large LDL-C particle size. In this case report, we present a case of a rapid increase, followed by a rapid correction of LDL-C, in a patient following a ketogenic diet.

Figure 1. A large fat density lesion with some septations measuring 3.7 cm. There is surrounding marked thickening of the loop of small bowel proximal to this extending over a length of 15.2 cm, representing a segment of intussusception.

Discussion: Ectopic varices account for up to 5% of variceal bleeds with a bleeding rate thought to be 4 times higher than esophageal varices and a reported mortality up to 40%. About 17% are jejunal/ileal varices. Rapid detection and treatment by embolization and reduction in portal pressures via TIPS, BRTO or portal vein stenting are key. In our patient, despite delay in diagnosis due to intermittent bleeding, hemostasis was finally achieved with direct embolization and reduction in portal pressure. It is imperative that a high suspicion be maintained for ectopic varices in any patient with portal hypertension and intra/extraluminal signs of bleeding, and other modalities such as MRA or CT enterography be utilized if endoscopy/CTA are non-revealing.[2668] Figure 1. Figure: (a) Sagittal view of computed tomography angiography (CTA) and (b) angiogram evidence of jejunal blush and ectopic jejunal varix with aberrant connection to the left ovarian vein, respectively.