Muhammad YN. Chaudhary, MBChB1, Muhammad Ismail, MD2, Oluwagbenga Serrano, MD, FACG3 1Indiana University Southwest, Evansville, IN; 2Indiana University Southwest, Cedar Rapids, IA; 3Good Samaritan Hospital, Vincennes, IN
Introduction: Eosinophilic Granulomatosis with Polyangiitis (EGPA), formerly Churg-Strauss syndrome, is a rare systemic vasculitis marked by eosinophilic infiltration and granuloma formation, typically affecting the respiratory tract, skin, and peripheral nerves. Gastrointestinal (GI) involvement is uncommon and presents a diagnostic challenge due to nonspecific symptoms. This case report highlights a rare presentation of EGPA with predominant GI manifestations, underscoring the importance of considering EGPA in patients with unexplained GI symptoms.
Case Description/Methods: A 45-year-old female with a history of asthma presented with a three-month history of recurrent abdominal pain, diarrhea, and unintended weight loss. Physical examination revealed mild epigastric tenderness without palpable masses. Laboratory investigations showed peripheral eosinophilia (eosinophil count of 1800 cells/μL), elevated inflammatory markers, and mild hypoalbuminemia. Stool studies were negative for infectious pathogens. Upper GI endoscopy revealed diffuse erythema, friability, and multiple aphthous ulcers throughout the esophagus, stomach, and duodenum. Biopsies demonstrated prominent eosinophilic infiltration consistent with EGPA. Serological testing revealed positive perinuclear ANCA (p-ANCA) with myeloperoxidase (MPO) specificity. Imaging studies showed no evidence of vasculitic involvement in other organs. The patient was diagnosed with EGPA and treated with corticosteroids and immunosuppressants, leading to significant clinical improvement.
Discussion: EG can mimic other GI disorders such as inflammatory bowel disease and infections, which often leads to misdiagnosis or delayed diagnosis. The absence of common allergic or atopic history, which is frequently associated with EG, provides novelty in this case. This emphasizes the need for a high index of suspicion in atypical presentations. Additionally, the successful use of medications typically used for atopic conditions, such as corticosteroids, in a patient without an atopic history opens new avenues for treatment strategies.
This case highlights the necessity for further research into the mechanisms underlying EG, particularly in non-atopic individuals, and the potential benefits of using traditional atopic treatments in these patients.
Disclosures:
Muhammad Chaudhary indicated no relevant financial relationships.
Muhammad Ismail indicated no relevant financial relationships.
Oluwagbenga Serrano: MERCK – Stock-publicly held company(excluding mutual/index funds).
Muhammad YN. Chaudhary, MBChB1, Muhammad Ismail, MD2, Oluwagbenga Serrano, MD, FACG3. P3789 - Eosinophilic Gastroenteritis: A Case Report, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
