Eosinophilic gastroenteritis-induced intestinal obstruction.

A 53-year-old man presented with abdominal pain and distension, accompanied with vomiting, and weight loss. Then he was treated with gastrointestinal decompression and enema, but the symptom of abdominal pain and distension continued with no relief. He had no drug or food allergies. He had no family history of liver disease, tuberculosis, asthma, and coagulation disorder. On physical examination, the patient had normal vital signs, abdominal distention, and generalized abdominal pain at palpation, with no rebound tenderness. Laboratory findings revealed significantly elevated white blood cells (14.28x109/L), eosinophils (8.23x109/L), C-reactive protein (13.5 mg/L), Serum IgE (487.83 μg/ml), and decreased albumin (34.6 g/L). There was no evidence of a recent infection with malaria, Lyme disease, hepatitis A, B, C or E viruses, Epstein-Barr virus (EBV), cytomegalovirus (CMV) or HIV. Antinuclear antibody was negative. His blood, stool, urine cultures, Clostridium difficile toxin, tumor markers, and T-spot test were negative and chest computed tomography (CT) was normal. Abdominal CT revealed dilatation of all duodenum, jejunum, ileum, and colon with thickened walls. Gastroscope showed hyperemia and edema in the gastric antrum mucosa. Double-balloon enteroscopy and Colonoscopy showed congestion in the small intestinal mucosa and colon mucosa. The histopathology of biopsies from the gastric antrum mucosa and small intestinal mucosa revealed visible eosinophil infiltration (38 and 52 eosinophils per HPF; a normal range at this anatomic site of 20 eosinophils per HPF), repectively. Therefore, the patient was diagnosed with eosinophilic gastroenteritis and intestinal obstruction. Then the patient was treated with an oral intake of prednisone 40 mg daily. Within three weeks, his abdominal distension was in complete relief. And prednisone was administered orally in decreasing amounts over that period. The patient was general in good condition during the follow-up period until now.