Eosinophilic Gastroenteritis Presenting with Severe Anemia and Near Syncope

Abstract

Eosinophilic gastrointestinal disorders or eosinophilic digestive disorders encompass a spectrum of rare gastrointestinal disorders that includes eosinophilic esophagitis, eosinophilic gastroenteritis, and eosinophilic colitis. Eosinophilic gastroenteritis is a rare inflammatory disease characterized by eosinophilic infiltration of the gastrointestinal tract. The clinical manifestations include anemia, dyspepsia, and diarrhea. Endoscopy with biopsy showing histologic evidence of eosinophilic infiltration is considered definitive for diagnosis. Corticosteroid therapy, food allergen testing, elimination diets, and elemental diets are considered effective treatments for eosinophilic gastroenteritis. The treatment and prognosis of eosinophilic gastroenteritis is determined by the severity of the clinical manifestations. We describe a 24-year-old woman with eosinophilic gastroenteritis presenting as epigastric pain with a history of severe iron deficiency anemia, asthma, eczema, and allergic rhinitis, and we review the literature regarding presentation, diagnostic testing, pathophysiology, predisposing factors, and treatment recommendations. (J Am Board Fam Med 2012;25:913-918.) Keywords: Case Reports, Eosinophilic Gastroenteritis, Gastrointestinal DisordersA 24-year-old nulliparous African-American woman was admitted after an episode of near syncope associated with 2 days of fatigue and dizziness. She reported gradual onset of dyspepsia over 2 to 3 months. She denied nausea, vomiting, menorrhagia, polymenorrhea, diarrhea, hematemesis, melena, or hematochezia. Her medical history was significant for allergic rhinitis, eczema, and asthma. Her surgical history was negative. She denied using tobacco or illicit drugs. She drank approximately 1 to 2 beers per month. Her family history was significant for a father with asthma and hypertension and a mother with hypertension. Her medications included inhaled fluticasone, an albuterol metered-dose inhaler, a Flovent inhaler, loratadine, and ranitidine.During examination, her height was 62 inches, weight 117 lb, and body mass index 21.44 kg/m 2 . Her heart rate was 111 beats per minute, blood pressure 121/57 mm Hg, respiratory rate 20 breaths per minute, and oral temperature of 98.6°F. She appeared acutely ill and lethargic. She was oriented to person, place, and time. She had pallor of the conjunctiva. Cardiovascular, respiratory, musculoskeletal, and neurological examinations were normal. Her abdomen was soft and nontender, without organomegaly. Rectal examination revealed brown stool that was hemoccult negative.Initial laboratory tests revealed a hemoglobin level of 5.1 g/dL (normal range, 12.0-16.0 g/dL), a hematocrit level of 17.1% (normal, 37.0% to 47.0%), a mean corpuscular volume of 66.9 fL (normal, 80.0 -98.0 fL), a red blood cell distribution width of 31.1%F (normal, 11.5-18.0%F), and a platelet count of 921,000/mm 3 (normal, 150,000 -400,000/mm 3 ). The white blood cell differential included 82% neutrophils, 5% lymphocytes, 5% monocytes, 6% eosinophils, and 2% basop...

Prostate Cancer Decision-Making, Health Services, and the Family Physician Workforce

“…Our brief reports provide helpful information and reminders: the sternoclavicular joint can be the site of septic arthritis 19 ; the serious consequences of eosinophilic gastroenteritis 20 ; and a reminder that vaccinations can cause serious difficulties along with helpful hints for relevant staff training.…”