Sclerosing encapsulating peritonitis is a rare condition caused by a fibrotic membrane covering the small bowel which may lead to abdominal pain or obstruction. The cause may be primary and idiopathic or secondary to several diseases, treatments, and/or medications. The condition typically presents with bowel obstruction, and only one previous case has described ascites as the presenting sign. Sclerosing encapsulating peritonitis is typically diagnosed intraoperatively. We present a case of a patient who presented with atypical clinical symptoms including respiratory distress, recurrent abdominal ascites, and failure to thrive who was diagnosed nonoperatively.

Infective endocarditis (IE) caused by Aerococcus urinae is rare. The true incidence rate of this pathogen is likely underestimated as this is easily misidentified as Staphylococci or Streptococci . It is also associated with increased risk of complications such as systemic emboli. Aerococcus usually affects elderly males with underlying urological conditions. Here we present a case of IE with this rare Aerococcus urinae in a young man with a bioprosthetic aortic valve, despite negative urine cultures.

Introduction: Celiac disease is an immune mediated reaction to the gluten protein. this disease primarily affects the small intestine.it occurs in population with genetic predisposition, usually resolves with gluten free diet regimen. it was reported the association between eosinophilic gastrointestinal diseases and celiac disease but in the following case will discuss patient with significant peripheral eosinophilia and celiac disease without Eosinophilic gastrointestinal disorder. Case Description/Methods: 45 years old male, with history of hypertension, who presented with progressively worsening intermittent colicky lower abdominal pain for the past 2 months. Associated with recurrent episodes of nausea and vomiting, and non-bloody watery diarrhea.Patient Labs were significant for Hemoglobin 12 gm/dL, WBC's 26,000 with 62% Eosinophils (16,500 /uL), Platelet of 332 Thou/uL. Peripheral blood smear was negative for parasites, stool was negative for parasites or bacterial infection. Patient went upper GI endoscopy that showed grade A reflux esophagitis, congestive gastropathy, Duodenitis, and non-bleeding gastric ulcer, Biopsies were obtained during the EGD. Pathology showed Duodenal mucosa with mild villous atrophy and focal increased intraepithelial lymphocytes suggestive of celiac disease,chronic gastritis, esophageal biopsy was negative for increased eosinophils. Patient was started on gluten free diet that was resulted in gradual resolution of his symptoms and also normal eosinophilic count after 1 month. (Figure ) Discussion: Patient with celiac disease can present with typical gastrointestinal symptoms such as diarrhea, weight loss, bloating, abdominal pain, and also non-gastrointestinal abnormalities such as abnormal liver function test, iron deficiency anemia, and it may be asymptomatic. In this case patient presented with typical symptoms but was associated with significant peripheral eosinophilia, without evidence eosinophilic gastrointestinal disorder.[3390] Figure 1. EGD showing stomach and duodenum.

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