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Eosinophilia in a patient with cyclical vomiting: a case report.

Copeland BH, Aramide OO, Wehbe SA, Fitzgerald SM, Krishnaswamy G - Clin Mol Allergy (2004)

Bottom Line: CASE PRESENTATION: The patient is a 31 year old Caucasian female with a past medical history significant for ulcerative colitis.This was associated with extreme weakness and cachexia.CONCLUSIONS: The patient responded to a combination of glucocorticosteroids and azathioprine with decreased eosinophilia and symptoms.

View Article: PubMed Central - HTML - PubMed

Affiliation: P,O, Box 70622, Department of Internal Medicine, Division of Allergy and Immunology, East Tennessee State University, Johnson City, TN 37614, USA. bhcopelandII@aol.com

ABSTRACT
BACKGROUND: Eosinophilic gastritis is related to eosinophilic gastroenteritis, varying only in regards to the extent of disease and small bowel involvement. Common symptoms reported are similar to our patient's including: abdominal pain, epigastric pain, anorexia, bloating, weight loss, diarrhea, ankle edema, dysphagia, melaena and postprandial nausea and vomiting. Microscopic features of eosinophilic infiltration usually occur in the lamina propria or submucosa with perivascular aggregates. The disease is likely mediated by eosinophils activated by various cytokines and chemokines. Therapy centers around the use of immunosuppressive agents and dietary therapy if food allergy is a factor. CASE PRESENTATION: The patient is a 31 year old Caucasian female with a past medical history significant for ulcerative colitis. She presented with recurrent bouts of vomiting, abdominal pain and chest discomfort of 11 months duration. The bouts of vomiting had been reoccurring every 7-10 days, with each episode lasting for 1-3 days. This was associated with extreme weakness and cachexia. Gastric biopsies revealed intense eosinophilic infiltration. The patient responded to glucocorticoids and azathioprine. The differential diagnosis and molecular pathogenesis of eosinophilic gastritis as well as the molecular effects of glucocorticoids in eosinophilic disorders are discussed. CONCLUSIONS: The patient responded to a combination of glucocorticosteroids and azathioprine with decreased eosinophilia and symptoms. It is likely that eosinophil-active cytokines such as interleukin-3 (IL-3), granulocyte macrophage colony stimulating factor (GM-CSF) and IL-5 play pivotal roles in this disease. Chemokines such as eotaxin may be involved in eosinophil recruitment. These mediators are downregulated or inhibited by the use of immunosuppressive medications.

No MeSH data available.


Related in: MedlinePlus

Esophagogastroduodenoscopy showing gastric erosion (A) and esophogitis (B). Panels C and D show eosinophil infiltration of gastric biopsy samples.
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Figure 1: Esophagogastroduodenoscopy showing gastric erosion (A) and esophogitis (B). Panels C and D show eosinophil infiltration of gastric biopsy samples.

Mentions: The patient underwent esophagogastroduodenoscopy (EGD) and had multiple gastric biopsies taken by a consultant gastroenterologist. Images revealed multiple erosions in the gastric and duodenal mucosa and Barrett's esophagitis (Figure 1A and 1B). Gastric biopsy showed eosinophilic infiltration of the mucosa in clusters, a diagnostic feature of eosinophilic gastritis (Figure 1C and 1D). Duodenal and ileal biopsies demonstrated no eosinophilic infiltration. Viral inclusions were absent on biopsy tissue and no evidence of celiac disease was present. Follow up colonoscopy revealed some colitis involving the rectosigmoid colon, with neutrophilic infiltration but no crypt abscesses. Cecal, right colon and ileal biopsies were normal and these findings were improved from prior studies.


Eosinophilia in a patient with cyclical vomiting: a case report.

Copeland BH, Aramide OO, Wehbe SA, Fitzgerald SM, Krishnaswamy G - Clin Mol Allergy (2004)

Esophagogastroduodenoscopy showing gastric erosion (A) and esophogitis (B). Panels C and D show eosinophil infiltration of gastric biopsy samples.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC425596&req=5

Figure 1: Esophagogastroduodenoscopy showing gastric erosion (A) and esophogitis (B). Panels C and D show eosinophil infiltration of gastric biopsy samples.
Mentions: The patient underwent esophagogastroduodenoscopy (EGD) and had multiple gastric biopsies taken by a consultant gastroenterologist. Images revealed multiple erosions in the gastric and duodenal mucosa and Barrett's esophagitis (Figure 1A and 1B). Gastric biopsy showed eosinophilic infiltration of the mucosa in clusters, a diagnostic feature of eosinophilic gastritis (Figure 1C and 1D). Duodenal and ileal biopsies demonstrated no eosinophilic infiltration. Viral inclusions were absent on biopsy tissue and no evidence of celiac disease was present. Follow up colonoscopy revealed some colitis involving the rectosigmoid colon, with neutrophilic infiltration but no crypt abscesses. Cecal, right colon and ileal biopsies were normal and these findings were improved from prior studies.

Bottom Line: CASE PRESENTATION: The patient is a 31 year old Caucasian female with a past medical history significant for ulcerative colitis.This was associated with extreme weakness and cachexia.CONCLUSIONS: The patient responded to a combination of glucocorticosteroids and azathioprine with decreased eosinophilia and symptoms.

View Article: PubMed Central - HTML - PubMed

Affiliation: P,O, Box 70622, Department of Internal Medicine, Division of Allergy and Immunology, East Tennessee State University, Johnson City, TN 37614, USA. bhcopelandII@aol.com

ABSTRACT
BACKGROUND: Eosinophilic gastritis is related to eosinophilic gastroenteritis, varying only in regards to the extent of disease and small bowel involvement. Common symptoms reported are similar to our patient's including: abdominal pain, epigastric pain, anorexia, bloating, weight loss, diarrhea, ankle edema, dysphagia, melaena and postprandial nausea and vomiting. Microscopic features of eosinophilic infiltration usually occur in the lamina propria or submucosa with perivascular aggregates. The disease is likely mediated by eosinophils activated by various cytokines and chemokines. Therapy centers around the use of immunosuppressive agents and dietary therapy if food allergy is a factor. CASE PRESENTATION: The patient is a 31 year old Caucasian female with a past medical history significant for ulcerative colitis. She presented with recurrent bouts of vomiting, abdominal pain and chest discomfort of 11 months duration. The bouts of vomiting had been reoccurring every 7-10 days, with each episode lasting for 1-3 days. This was associated with extreme weakness and cachexia. Gastric biopsies revealed intense eosinophilic infiltration. The patient responded to glucocorticoids and azathioprine. The differential diagnosis and molecular pathogenesis of eosinophilic gastritis as well as the molecular effects of glucocorticoids in eosinophilic disorders are discussed. CONCLUSIONS: The patient responded to a combination of glucocorticosteroids and azathioprine with decreased eosinophilia and symptoms. It is likely that eosinophil-active cytokines such as interleukin-3 (IL-3), granulocyte macrophage colony stimulating factor (GM-CSF) and IL-5 play pivotal roles in this disease. Chemokines such as eotaxin may be involved in eosinophil recruitment. These mediators are downregulated or inhibited by the use of immunosuppressive medications.

No MeSH data available.


Related in: MedlinePlus