PDF(Pubmed)
Abstract：
Eosinophilic enteritis (EoN) poses a distinctive challenge, affecting individuals with various clinical presentations depending on the layer and extent of the bowel wall. We present a case of a 19-year-old female with abdominal pain, vomiting, and loose stools for 1 month. Labs were significant for persistent leukocytosis with peripheral eosinophilia. A computed tomography of the abdomen/pelvis demonstrated moderate abdominal ascites and moderately diffuse mucosal thickening of jejunal loops. A diagnostic paracentesis unveiled low serum ascites albumin gradient and 92% eosinophils. Push enteroscopy resulted in no significant biopsy findings, though a laparoscopic full-thickness jejunal biopsy exhibited increased eosinophils in the bowel wall. Intravenous steroid, proton pump inhibitor, and dietary changes resolved the symptoms and normalized the labs within a week. Our case report highlights a variable presentation of eosinophilic jejunitis uncommon in this disease population. EoN is an easily missed diagnosis and mandates frequent follow-up to prompt relevant investigations. Atopic clinical features are not prevalent in each case. While rare, EoN requires a strong clinical suspicion, even if endoscopic biopsies are unremarkable, prompting timely laparoscopic full-thickness biopsy. Per protocol, physicians must do the infectious and eosinophilia workup to rule out other etiologies. Our case also highlights that worsening clinical condition in EoN warrants early intravenous steroids with a favorable prognosis and considers a psychosocial aspect of the disease on the patient\'s health.
摘要：
嗜酸性粒细胞性肠炎（EoN）提出了一个独特的挑战，根据肠壁的层和范围影响具有各种临床表现的个体。我们介绍了一个19岁女性腹痛的病例，呕吐,和松散的大便1个月。实验室对于伴有外周嗜酸性粒细胞增多的持续性白细胞增多具有重要意义。腹部/骨盆的计算机断层扫描显示中度腹水和中度弥漫性空肠环粘膜增厚。诊断性穿刺术揭示了低血清腹水白蛋白梯度和92％的嗜酸性粒细胞。推进式小肠镜检查没有明显的活检结果，尽管腹腔镜全层空肠活检显示肠壁嗜酸性粒细胞增加。静脉注射类固醇,质子泵抑制剂,饮食的改变解决了症状，并在一周内使实验室恢复正常。我们的病例报告强调了该疾病人群中罕见的嗜酸性粒细胞性骨髓炎的可变表现。EoN是一个容易漏诊的诊断，并要求频繁的随访以提示相关的调查。在每种情况下，异位临床特征并不普遍。虽然罕见，EoN需要强烈的临床怀疑，即使内窥镜活检不明显，提示及时腹腔镜全层活检。根据协议，医生必须进行传染性和嗜酸性粒细胞增多检查以排除其他病因.我们的病例还强调，EoN的临床状况恶化需要早期静脉注射类固醇，预后良好，并考虑了该疾病对患者健康的社会心理方面。
