Tommy Nguyen, DO1, Abhinav Goyal, MD1, Christopher Hibbard, DO2; 1Albert Einstein Medical Center, Philadelphia, PA; 2Albert Einstein Healthcare Network/Digestive Disease and Transplantation, Philadelphia, PA
Introduction: Eosinophilic colitis (EC) is a condition that belongs to a larger group known as eosinophilic gastrointestinal disorders (EGID). Patients with EC most frequently report diarrhea but other non-specific symptoms can occur. EC remains a diagnostic challenge as there is a lack of consensus regarding endoscopic findings and histological thresholds for eosinophils. We report a case of an asymptomatic male who was found to have endoscopic and histological findings consistent with EC.
Methods: A 61 year-old male with a history of hypertension, type 2 diabetes mellitus and history of colon polyps presented for outpatient colorectal cancer (CRC) screening. He denied any gastrointestinal symptoms including abdominal pain, constipation, diarrhea, hematochezia and melena. No history of drug or food allergies. His medications included amlodipine, lisinopril, aspirin, simvastatin, metformin, glipizide, repaglinide and tadalafil. He underwent colonoscopy which showed a 3 mm sessile polyp in the transverse colon that was removed with cold biopsy forceps and scattered small round whitish mucosal exudates throughout the entire colon. Biopsies were taken from the area of exudates. Pathology of the biopsies showed eosinophilic colitis. Discussion: We present a case of biopsy proven eosinophilic colitis presenting in an asymptomatic male. EC is poorly characterized and likely underdiagnosed due to a lack of diagnostic criteria. It has been previously described in young adults with other atopic disorders. Our case is unique because of presence of colonic eosinophilia on histology and eosinophilic exudates on colonoscopy in an asymptomatic male patient in his 6th decade of life in absence of any atopic or allergic condition. Cases of incidentally found colonic eosinophilia have been previously reported but endoscopic findings of white exudates with colonic eosinophilia on histology led us to believe that this is a case of asymptomatic EC rather than incidentally found colonic eosinophilia. This case highlights the importance of considering eosinophilic colitis when encountering the endoscopic finding of whitish mucosal exudates even in asymptomatic patients. Perhaps, these patients need to be followed to monitor for development of symptoms later in life.
Image 1: Ascending colon, white mucosal exudates corresponding to eosinophilic colitis.
Disclosures: Tommy Nguyen indicated no relevant financial relationships. Abhinav Goyal indicated no relevant financial relationships. Christopher Hibbard indicated no relevant financial relationships.