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Eosinophilic gastroenteritis due to rhus ingestion presenting with gastrointestinal hemorrhage.

Choi W, Park SY, Choi C, Cho K, Park CH, Kim HS, Choi SK, Rew JS - Clin Endosc (2015)

Bottom Line: Abdominal computed tomography revealed edematous wall thickening of the duodenum and proximal jejunal loops.Patch testing with Rhus extracts showed a strong positive reaction, suggesting Rhus as the allergen.Her symptoms improved after avoidance of the allergen.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.

ABSTRACT
Rhus-related illnesses in Korea are mostly caused by ingestion of parts of the Rhus tree. Contact dermatitis occurrence after ingestion of Rhus-related food is very common in Korea. However, Rhus-related gastrointestinal disease is very rare. Herein, we present a case of eosinophilic gastroenteritis caused by Rhus ingestion. A 75-year-old woman was admitted with hematemesis and hematochezia after Rhus extract ingestion. Routine laboratory tests revealed leukocytosis without eosinophilia. Endoscopy showed friable and granular mucosal changes with touch bleeding in the second portion of the duodenum. Abdominal computed tomography revealed edematous wall thickening of the duodenum and proximal jejunal loops. Patch testing with Rhus extracts showed a strong positive reaction, suggesting Rhus as the allergen. Her symptoms improved after avoidance of the allergen.

No MeSH data available.


Related in: MedlinePlus

(A-D) Follow-up endoscopy image showing continued improvement of the mucosal edema and nodularity in the duodenum.
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Figure 5: (A-D) Follow-up endoscopy image showing continued improvement of the mucosal edema and nodularity in the duodenum.

Mentions: A 75-year-old woman was admitted to the emergency room complaining of hematemesis and hematochezia. She also had epigastric pain, nausea, and vomiting but no fever, weight loss, or rash. Her blood pressure was 110/70 mm Hg, heart rate 72 beats per minute, and respiratory rate 18 breaths per minute. She ingested Rhus extract 2 days prior. Laboratory examination results were as follows: leukocytes, 20,900/mm3 (neutrophils, 82%; lymphocytes, 8.9%; eosinophils, 0.1%; monocytes, 8.9%; basophils, 0.1%); hemoglobin, 14.4 g/dL; platelets, 86,000/mm3; and immunoglobulin E, 81.90 IU/mL (normal range, 0 to 100). The albumin level was low (2.9 g/dL; normal range, 3.5 to 5.5 g/dL) but other liver and renal function indicators were within the normal range. Acute phase reactants were elevated (C-reactive protein, 13.8 mg/dL; erythrocyte sedimentation rate, 22 mm/hr). Parasitologic examination and bacterial culture of stool results were normal. Abdominal computed tomography revealed edematous wall thickening of the duodenum and proximal jejunal loops (Fig. 1). Endoscopy showed friable and granular mucosal changes with touch bleeding in the second portion of the duodenum (Fig. 2). During the endoscopic examina-tion, multiple duodenal biopsies were taken. Pathologic find-ings showed edematous gastric mucosa and diffusely infiltrated inflammatory cells containing over 100 eosinophils per high power field, consistent with EGE (Fig. 3). For the evaluation of allergy, we performed a patch test with Rhus extracts ingested by the patient. We applied the Rhus extract-containing patch to the patient's back for 48 hours and then removed it. Seventy-two hours after patch application, the skin showed erythematous infiltration with ulceration, indicating a strong positive reaction (Fig. 4). We concluded that the Rhus extract provoked a type IV hypersensitivity reaction on the skin, and that it may be the allergen causing EGE. After avoidance of the allergen, the patient's symptoms remitted. One-month follow-up endoscopy showed improving mucosal edema and nodularity in the duodenum (Fig. 5).


Eosinophilic gastroenteritis due to rhus ingestion presenting with gastrointestinal hemorrhage.

Choi W, Park SY, Choi C, Cho K, Park CH, Kim HS, Choi SK, Rew JS - Clin Endosc (2015)

(A-D) Follow-up endoscopy image showing continued improvement of the mucosal edema and nodularity in the duodenum.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4381147&req=5

Figure 5: (A-D) Follow-up endoscopy image showing continued improvement of the mucosal edema and nodularity in the duodenum.
Mentions: A 75-year-old woman was admitted to the emergency room complaining of hematemesis and hematochezia. She also had epigastric pain, nausea, and vomiting but no fever, weight loss, or rash. Her blood pressure was 110/70 mm Hg, heart rate 72 beats per minute, and respiratory rate 18 breaths per minute. She ingested Rhus extract 2 days prior. Laboratory examination results were as follows: leukocytes, 20,900/mm3 (neutrophils, 82%; lymphocytes, 8.9%; eosinophils, 0.1%; monocytes, 8.9%; basophils, 0.1%); hemoglobin, 14.4 g/dL; platelets, 86,000/mm3; and immunoglobulin E, 81.90 IU/mL (normal range, 0 to 100). The albumin level was low (2.9 g/dL; normal range, 3.5 to 5.5 g/dL) but other liver and renal function indicators were within the normal range. Acute phase reactants were elevated (C-reactive protein, 13.8 mg/dL; erythrocyte sedimentation rate, 22 mm/hr). Parasitologic examination and bacterial culture of stool results were normal. Abdominal computed tomography revealed edematous wall thickening of the duodenum and proximal jejunal loops (Fig. 1). Endoscopy showed friable and granular mucosal changes with touch bleeding in the second portion of the duodenum (Fig. 2). During the endoscopic examina-tion, multiple duodenal biopsies were taken. Pathologic find-ings showed edematous gastric mucosa and diffusely infiltrated inflammatory cells containing over 100 eosinophils per high power field, consistent with EGE (Fig. 3). For the evaluation of allergy, we performed a patch test with Rhus extracts ingested by the patient. We applied the Rhus extract-containing patch to the patient's back for 48 hours and then removed it. Seventy-two hours after patch application, the skin showed erythematous infiltration with ulceration, indicating a strong positive reaction (Fig. 4). We concluded that the Rhus extract provoked a type IV hypersensitivity reaction on the skin, and that it may be the allergen causing EGE. After avoidance of the allergen, the patient's symptoms remitted. One-month follow-up endoscopy showed improving mucosal edema and nodularity in the duodenum (Fig. 5).

Bottom Line: Abdominal computed tomography revealed edematous wall thickening of the duodenum and proximal jejunal loops.Patch testing with Rhus extracts showed a strong positive reaction, suggesting Rhus as the allergen.Her symptoms improved after avoidance of the allergen.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.

ABSTRACT
Rhus-related illnesses in Korea are mostly caused by ingestion of parts of the Rhus tree. Contact dermatitis occurrence after ingestion of Rhus-related food is very common in Korea. However, Rhus-related gastrointestinal disease is very rare. Herein, we present a case of eosinophilic gastroenteritis caused by Rhus ingestion. A 75-year-old woman was admitted with hematemesis and hematochezia after Rhus extract ingestion. Routine laboratory tests revealed leukocytosis without eosinophilia. Endoscopy showed friable and granular mucosal changes with touch bleeding in the second portion of the duodenum. Abdominal computed tomography revealed edematous wall thickening of the duodenum and proximal jejunal loops. Patch testing with Rhus extracts showed a strong positive reaction, suggesting Rhus as the allergen. Her symptoms improved after avoidance of the allergen.

No MeSH data available.


Related in: MedlinePlus