Published online Jul 16, 2018. doi: 10.12998/wjcc.v6.i7.156
Peer-review started: February 19, 2018
First decision: March 12, 2018
Revised: May 2, 2018
Accepted: May 30, 2018
Article in press: May 30, 2018
Published online: July 16, 2018
Processing time: 148 Days and 7.6 Hours
According to Klein’s classification system, the symptomatology of eosinophilic gastroenteritis (EG), a rare disease, differs based on the affected tissue layer. Patients with subserosal EG often have peritoneal effusion. Hemorrhagic ascites due to EG is extremely rare and has not been reported in the literature. Here, we report a 57-year-old woman with EG and massive hemorrhagic ascites. Laboratory investigations showed elevated peripheral eosinophils with significant eosinophilia (65.6%). Ultrasonography showed massive abdominal ascites. Abdominal paracentesis revealed hemorrhagic peritoneal fluid and microscopy showed predominant eosinophils. Upper gastrointestinal endoscopy revealed erosions, exudates, and mucosal rings in the duodenal mucosa; histological examination indicated eosinophilic infiltration. EG presenting with hemorrhagic ascites was diagnosed by histologic examination of eosinophilic infiltration. She was empirically treated with ketotifen 1 mg bid po with rapid resolution of ascites and a remarkable decline in peripheral eosinophil counts. Clinicians should consider the differential diagnosis of unexplained hemorrhagic ascites.
Core tip: Eosinophilic gastroenteritis (EG) with ascites is extremely rare. We report a 57-year-old woman with EG and massive hemorrhagic ascites who underwent endoscopy and abdominal paracentesis. Differential diagnoses included other causes of tissue eosinophilia. The patient was in good condition 1 year after drug therapy with no recurrence of ascites and gastrointestinal symptoms. To our knowledge, this is the first report of a rare case of massive hemorrhagic ascites in EG. Clinicians should consider the differential diagnosis of unexplained hemorrhagic ascites, especially in patients with gastrointestinal mucosa lesion, peripheral eosinophilia, and ascites.