Nassau University Medical Center East Meadow, NY, United States
Rucha Jiyani, MD1, Bobby Jacob, MD2, Nausheer Khan, MD1, Kaleem Rizvon, MD1 1Nassau University Medical Center, East Meadow, NY; 2Nassau University Medical Center, Lake Grove, NY
Introduction: Gut eosinophilia develops secondary to recognized entities, such as reflux esophagitis, H. pylori infection, medications, vasculitis, inflammatory bowel disease, malignancy and parasitic infections. Primary eosinophilic gastrointestinal disorders (EGID) represent a spectrum of disorders in which eosinophil infiltrate the gut mucosa in the absence of known causes. Primary EGID can be sub grouped as Eosinophilic esophagitis, Eosinophilic gastroenteritis and Eosinophilic colitis (EC). Here we present a case of rarest subtype of EGID, EC.
Case Description/Methods: 45 year old Hispanic male presented to clinic with complaints of chronic diarrhea and abdominal pain for 2 years. Patient denies use of medications or family history of any inflammatory bowel disease or colon cancer. Extensive stool testing revealed secretory diarrhea, negative for H. pylori and ova and. Colonoscopy with random biopsies were obtained from the colon and revealed inflammation with greater than 30 eosinophils/PHF. Patients lab work revealed peripheral eosinophilia. 6 food elimination diet was recommended and patient was started on empiric prednisone 20mg daily for 2 weeks, which was tapered to 15mg for two weeks and currently he is on 10mg with reported improvement in symptoms. Patient clinically improved on steroids and is scheduled for a repeat colonoscopy with repeat biopsies to evaluate if resolution of eosinophilia in the colon.
Discussion: EC is exceptionally rare sub type of EGID, which has a bimodal age of onset with usually benign course in infancy and resolves with dietary changes. An elemental or elimination diet is a therapeutic primary strategy for EGID and is beneficial in infancy, however it has limited effect in adult onset cases. Steroids have been used successfully in most cases in case series and reports, but has not been supported by evidence-based study or research. Eotaxin involved in migration of eosinophil provide base for role of immunomodulatory medications. Azathioprine and 6-Mercaptopurine are other possible evolutionary therapies particularly to be considered as steroid sparing. There are Leukotriene D4 antagonist, antihistamine and mast cell inhibitor, but no satisfactory data is been reported. Novel biologic such as Omalizumab and Mepolizumab through their effect on immunoglobulin E and Interleikin-5, are novel approach for refractory cases. Considering management challenges, small case series and case report like this might add in better understanding and management.
Rucha Jiyani indicated no relevant financial relationships.
Bobby Jacob indicated no relevant financial relationships.
Nausheer Khan indicated no relevant financial relationships.
Kaleem Rizvon indicated no relevant financial relationships.
Rucha Jiyani, MD1, Bobby Jacob, MD2, Nausheer Khan, MD1, Kaleem Rizvon, MD1. P1214 - Eosinophilic Colitis: A Rare Entity of Eosinophil-Associated Gastrointestinal Disorder, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.