背景:嗜酸细胞性十二指肠炎的患病率为5.1~8.2/100000人。潜在的分子机制是未知的,但超敏反应(季节性和食物过敏,哮喘,湿疹)反应在其发病机理中起主要作用,过敏倾向可以发现高达25-35%的病例。诊断包括临床表现,每个高倍视野的嗜酸性粒细胞浸润>20嗜酸性粒细胞的影像学发现和组织学证据。这是一个临床病例报告。一名25岁的白癜风患者向急诊科咨询消化不良症状,呕吐和最大强度的腹痛,在体检中发现上腹痛,血液实验室不显著,除了高净嗜酸性粒细胞计数>2000细胞/ul,腹部超声正常,上内镜检查显示十二指肠炎,皱褶坚硬且增厚,结肠镜检查显示痔疮I级。总IgE,IgA和IgG在正常范围内,报告弓形虫IgG阳性,自身免疫组阴性。在接下来的4天,腹痛和嗜酸性粒细胞计数增加,一项新的腹部-盆腔X线断层扫描显示十二指肠增厚,一项新的内镜检查显示十二指肠明显水肿伴严重胆道反流,活检描述萎缩性慢性十二指肠炎.过敏测试-皮肤点刺和贴片测试-进行了谷类检查(黑麦,大豆,大麦),Manihotesculenta,绿色香蕉,番茄,牛奶,橙子和菠萝。指示限制性饮食和质子泵抑制剂,在45天后进行动态控制,症状消退,血液嗜酸性粒细胞计数正常。据报道,一名患有白癜风的年轻人出现了与食物过敏有关的嗜酸性十二指肠炎,其临床表现异常为急性内脏痛和胆汁反流,通过消除饮食和泮托拉唑而不使用皮质激素来解决,两者,IgE和非IgE机制在解释食物致敏中起重要作用。
BACKGROUND: Eosinophilic duodenitis has a prevalence of 5.1 to 8.2 per 100000 persons. The underlying molecular mechanisms are unknown, but hypersensitivity (seasonal and food allergies, asthma, eczema) response plays a major role in its pathogenesis, allergic predisposition can be found up-to 25-35% of cases. The diagnosis includes clinical manifestation, imaging findings and histological evidence of eosinophilic infiltration >20 eosinophils per high-power field. This is a clinical
case report. a 25-years old man with vitiligo consult to emergency department referring dyspepsia symptoms, vomiting and abdominal pain of maximal intensity, in the medical exam upper abdominal pain was found, blood laboratories were unremarkable except a high net eosinophil-count >2000 cells/ul, abdominal ultrasound were normal, upper endoscopy revealed duodenitis with rigid and thickened folds, colonoscopy show hemorrhoids grade I. Coproscopy exam was negative for parasites, total IgE, IgA and IgG were in normal range, a positive IgG to Toxoplasma gondii was reported, autoimmunity panel was negative. In the following 4 days the abdominal pain and eosinophils count increase, a new abdomin-pelvic tomography was done showing thickened duodenum with a new endoscopy showing marked edema in duodenum with severe biliary reflux with biopsies describing an atrophic chronic duodenitis. Allergy tests -skin prick and patch tests- were done resulting positive to cereals (rye, soy, barley), Manihot esculenta, green banana, tomato, cow milk, orange and pineapple. A restrictive diet and protons pump inhibitor was indicated, ambulatory control at 45 days after show symptoms resolution with a normal blood eosinophils count. Here is reported a
case of eosinophilic duodenitis related to food allergy in a young man with vitiligo debuting with an unusual clinical presentation of acute visceral pain and biliary reflux which resolved with elimination diet and pantoprazole without use of corticoids, with both, IgE and non-IgE mechanisms playing important roles explaining food sensitization.