Catherine Choi, MD, Umair M. Nasir, DO, Pratik Deb, MD, Daniel Pievsky, DO, Yi Jiang, MD, Nikolaos T. Pyrsopoulos, MD, PhD, MBA, FRCP; Rutgers New Jersey Medical School, Newark, NJ
Introduction: Primary eosinophilic colitis is the least common entity among the eosinophilic gastrointestinal disorders. Due to its rarity and a lack of standardized diagnostic criteria, no true incidence or prevalence is known. While the most common symptoms of eosinophilic colitis in adults are abdominal pain and diarrhea, in the pediatric population hematochezia has been reported to be the one of presenting symptoms. We report a case of a patient with a known history of eosinophilic esophagitis who presented with isolated rectal bleeding.
Methods: A 42 year-old Polish woman presented with isolated rectal bleeding. She has a history of eosinophilic esophagitis, but never had rectal bleeding before. The patient denied any abdominal or rectal pain, diarrhea, fever, chills or coryza. She had no new medications. The physical examination was unremarkable. The patient underwent upper endoscopy and colonoscopy for further evaluation. The upper endoscopy was notable for felinization of esophagus but was otherwise normal. Biopsies from the distal and mid portions of the esophagus were consistent with eosinophilic esophagitis. Colonoscopy showed a single diminutive polyp in the transverse colon without any obvious sign of bleeding. Random biopsies from the colon showed colonic mucosa with marked eosinophilia, consistent with esophagitis colitis. The patient was offered corticosteroid therapy with Budesonide, but she declined the medical treatment. Her rectal bleeding resolved without intervention in a month. She was referred to allergy and immunology for allergy testing to optimize dietary management and for a multidisciplinary treatment approach. Discussion: As the clinical and endoscopic findings are often non-specific, a high clinical suspicion is critical in diagnosing eosinophilic colitis, especially with an unusual presentation as in our patient.
Photomicrography of the specimen shows eosinophils in the esophageal mucosa (Inset shows enlarged prominent eosinophils clustering together).
Photomicrography of the specimen shows eosinophils in the colonic mucosa (Inset shows abundant eosinophils in colonic mucosa).
Disclosures: Catherine Choi indicated no relevant financial relationships. Umair Nasir indicated no relevant financial relationships. Pratik Deb indicated no relevant financial relationships. Daniel Pievsky indicated no relevant financial relationships. Yi Jiang indicated no relevant financial relationships. Nikolaos Pyrsopoulos indicated no relevant financial relationships.