University of British Columbia North Vancouver, BC, Canada
Award: Presidential Poster Award
Leilynaz Malekafzali, BSc1, Bibi Naghibi Torbati, MD, FRCPC2, Fahd Jowhari, MD, FRCPC2 1University of British Columbia, North Vancouver, BC, Canada; 2University of British Columbia, Kelowna, BC, Canada
Introduction: Eosinophilic gastroenteritis (EGE), characterized by eosinophilic infiltration in the GI tract, often presents with non-specific symptoms such as abdominal pain, nausea or diarrhea with protein losing enteropathy. Eosinophilic dermatitis involves inflammatory eosinophilic infiltration in the skin causing a pruritic rash. It is uncommon for EGE to affect the skin. This case highlights the concurrent presentation of EGE and eosinophilic dermatitis in a patient who presented with a rash and gastrointestinal symptoms.
Case Description/Methods: A 68-year-old Caucasian female presented to hospital with a two week history of progressive epigastric pain, nausea and vomiting. Her past medical history was significant for three isolated episodes over the past 15 years of severe epigastric pain accompanied by a rash, both improving with short courses of Prednisone therapy. She also had a history of hypogammaglobulinemia suspected to be due to protein losing enteropathy. She had no known allergies or pertinent family history. On physical examination, her vital signs were normal. Abdomen was tender on deep palpation of the upper quadrants. An erythematous, pruritic, papular rash was noted on her left groin and thigh. Laboratory studies revealed peripheral blood eosinophilia of 0.7 x109/L (0.0-0.5) and hypoalbuminemia of 23 g/L. Gastroscopy revealed patchy erythema and inflammation in the stomach and duodenum. Targeted biopsies showed focal architectural distortion with increased eosinophilic infiltration in gastric body and duodenum consistent with EGE. A punch biopsy of the rash showed eosinophilic infiltration in the dermis layer consistent with eosinophilic dermatitis. She was started on oral prednisone 40 mg daily and a proton pump inhibitor (PPI) twice daily. Her abdominal symptoms resolved within 48 hours, and she was discharged home on a tapering course of prednisone and PPI. A follow-up gastroscopy 12 weeks later showed resolution of foregut mucosal changes and the rash subsequently improved.
Discussion: The diagnosis of EGE can be challenging as biochemical and endoscopic findings are usually non-specific. Peripheral blood eosinophilia may be present and histopathological analyses confirm the diagnosis. A pruritic rash, although not characteristic of the disease, could be present and may relate to underlying immunological processes involving eosinophils, mast cells, Th-2 cells and cytokines. Patients with EGE and a rash respond very well to a defined course of tapering steroid therapy.
Figure: Figure 1: a) Pruritic papular rash that developed on the patient’s left thigh. b) Punch biopsy from the rash shows heavy eosinophilic infiltration of the dermis layer (H&E stain).
Figure 2: a) Gastroscopy showed patchy erythematous duodenitis without discrete ulceration seen in D2. b) Duodenal biopsies from the inflamed areas show eosinophilic infiltration of the mucosal layer (H&E stain). c) Follow-up gastroscopy shows complete resolution of the duodenitis with normal appearing mucosa.
Disclosures: Leilynaz Malekafzali indicated no relevant financial relationships. Bibi Naghibi Torbati indicated no relevant financial relationships. Fahd Jowhari indicated no relevant financial relationships.
Leilynaz Malekafzali, BSc1, Bibi Naghibi Torbati, MD, FRCPC2, Fahd Jowhari, MD, FRCPC2. P0978 - A Case of Eosinophilic Gastroenteritis and Eosinophilic Dermatitis in a Patient: Two Sides of the Same Coin?, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.