P3296 - A Rare Case of Eosinophilic Gastrointestinal Disease With Transmural Wall Involvement

Ibrahim Al-Saadi, MB¹, Shivam Kalra, MBBS, MHA¹, Abhinav Rao, MD², Laura L. Brant, MD¹, Salvatore A. Moscatello, DO¹, Jose D. Espinal-marriote, MD^1
1Trident Medical Center, North Charleston, SC; ²Trident Medical Center, Charleston, SC

Introduction: Eosinophilic Gastrointestinal Disease (EGID) is an uncommon disease that is characterized by eosinophilic infiltration into the gastrointestinal wall to variable degrees and in different regions of the GI tract, leading to a wide range of symptoms (1,2). Here, we present a case of EGID with diffuse involvement of the small bowel, colon, and ascites.

Case Description/Methods: A 24-year-old African American female with a history of intermittent asthma, C-section, and substance abuse presented to the emergency department with complaints of crampy abdominal pain, non-bilious vomiting, and watery diarrhea for one week, and progressively worsening abdominal swelling for one month. Physical examination was remarkable for a moderately distended and tender abdomen with a fluid wave consistent with ascites.

Early laboratory work-up were significant for a leukocytosis of 15,900 cells/mm3 with eosinophilia (44%), INR of 1.28, and albumin of 2.8 g/dl. CT scan of the abdomen and pelvis with contrast revealed diffuse edematous wall thickening in the colon and small bowel consistent with pancolitis/enteritis, along with a developing obstruction and large volume ascites. A diagnostic paracentesis was done, and 25 ml of straw-colored ascitic fluid was drained with fluid analysis, revealing an increased cell count of 2899 with 89% eosinophils. Colonoscopy showed ileitis and colitis on gross assessment, with biopsies taken in a random fashion. Intravenous solumedrol was started empirically, and she had clinical improvement over the next several days. Biopsy results ultimately showed marked eosinophil infiltrate in the colon and ileum, consistent with eosinophilic gastroenteritis [ >100 per HPF].

Discussion: We present a rare case of EGID with diffuse and transmural involvement. Eosinophilic colitis is rare, with a prevalence of approximately 2.4-3.5/100,000 (3), and there are a few documented cases of transmural and diffuse involvement of the small bowel, large bowel, and ascites. The patient improved after treatment with IV steroids.







Disclosures:


Ibrahim Al-Saadi, MB¹, Shivam Kalra, MBBS, MHA¹, Abhinav Rao, MD², Laura L. Brant, MD¹, Salvatore A. Moscatello, DO¹, Jose D. Espinal-marriote, MD¹. P3296 - A Rare Case of Eosinophilic Gastrointestinal Disease With Transmural Wall Involvement, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.