Eosinophilic Cholecystitis Occurred in a Patient With Refractory Eosinophilic Airway Inflammation: A Case Report

Abstract

Background: Eosinophilic cholecystitis (EC) is a rare condition that presents in a manner comparable to acute cholecystitis. The diagnosis is based on classical symptoms of cholecystitis with excessive eosinophilic infiltration within the gallbladder. EC has been reported alone or in combination with manifestations, such as eosinophilic gastrointestinal tract inflammation. However, association with airway inflammation in patients with EC is rare. Case Presentation: We report the case of a 65-year-old man who had refractory eosinophilic chronic rhinosinusitis with bronchial asthma. A second endoscopic sinus surgery (ESS) was performed as treatment for recurrent nasal polyps. EC occurred while inhaled corticosteroids were reduced after ESS. Pathologic examination of the excised gallbladder demonstrated submucosal infiltration with a number of eosinophils. Furthermore, immunohistostaining revealed many galectin-10-positive cells in both the gallbladder mucosa and the paranasal sinus mucosa. Galectin-10 is a major constituent of human eosinophils, also known as the Charcot-Leyden crystal protein, which has been linked with eosinophilic inflammation. Interestingly, nasal polyps were reduced without any additional treatments 1 month after the cholecystectomy. Conclusions: We experienced a rare case wherein EC onset occurred in a patient with refractory eosinophilic airway inflammation during inhaled corticosteroid tapering. Galectin-10 might help diagnose rare cases of eosinophilic inflammation in multiple organs.

Eosinophilic Cholecystitis as an Atypical Etiology of Biliary Colic: A Case Report and Review of the Literature

“…Cases of EC associated with eosinophilic granulomatosis and polyangiitis have been reported [ 7 ], which makes it necessary to provide systemic treatment to avoid complications derived from these associated pathologies. On the other hand, there are associations with eosinophilic inflammation of the gastrointestinal tract [ 11 , 12 ] and even airway inflammation [ 11 ], eosinophilic granulomatous hepatitis, and eosinophilic ascites [ 12 ]. Kaji et al reported the case of a woman with EC and pericarditis; here, it is noteworthy that she presented high antibody titers against Ascaris lumbricoides and an adequate therapeutic response to management with albendazole alone [ 13 ].…”

Lymphoeosinophilic cholecystitis: A rare cause of acalculous cholecystitis in immunocompetent patients – A case report

“…Previous case reports and studies have suggested associations with various conditions including the following: parasitic infections (e.g. Ascaris spp, Clonorchis spp, Echinococcus spp ) [ [7] , [8] , [9] ], gastroenteritis [ 10 ], eosinophilic airway inflammation [ 11 ], allergies [ 12 ], hypereosinophilic syndromes [ 13 ], cephalosporins [ 14 ], and use of herbal medicines (e.g. 1-tryptophan) [ 15 ].…”

Eosinophil-mediated inflammation in the absence of eosinophilia

“…Our group has studied hundreds of tissues from patients with allergic or eosinophilic diseases [ 26 29 83 84 155 156 157 158 159 160 ]. In our tissue immunostaining experience, like Gleich et al, we have observed that the extracellular deposition of MBP is not disease-specific, but it is closely associated with tissue damage and the presence of eosinophil cytolysis.…”