SHM Converge Scientific Abstract ePoster Gallery-Eosinophilic Esophagitis: A Case of Atypical Presentation and Empiric Treatment

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This case describes a 44-year-old man with asthma who presented with 6 weeks of non-bloody diarrhea and marked abdominal distension, but no fever, chills, dysphagia, or abdominal pain. Physical exam showed significant ascites. Labs revealed leukocytosis and marked peripheral eosinophilia (absolute eosinophil count 7.34), while CMP, lipase, and infectious studies were normal. CT abdomen/pelvis showed diffuse gastrointestinal wall thickening, moderate ascites, and a possible jejunal lesion.<br /><br />Paracentesis removed 4.2 L of fluid that was highly eosinophilic. An esophageal biopsy demonstrated scattered intraepithelial eosinophils, with up to 15 eosinophils per high-power field, which is at the diagnostic threshold for eosinophilic esophagitis (EoE). Cytogenetic testing was negative.<br /><br />The report emphasizes that EoE is an immune-mediated disease characterized by eosinophilic infiltration of the esophageal mucosa, but it can rarely present with extra-intestinal manifestations such as ascites. In this patient, despite an atypical presentation and limited biopsy findings, clinicians suspected EoE and started empiric treatment. Symptoms resolved and the eosinophil count improved after therapy.<br /><br />Key takeaways are:<br />1. EoE can present atypically, including rare extra-intestinal manifestations.<br />2. Empiric treatment may be reasonable when clinical suspicion is high, even if diagnostic biopsies are not definitive.<br />3. As EoE becomes more common, clinicians should critically evaluate diagnostic criteria and testing methods.

Asset Subtitle

Alexandre Zaharia

Meta Tag

Author List Alexandre Zaharia, Andrea Olivas, Meagan Matuska

Category Clinical Vignettes

Concept Eosinophilic Esophagitis

Concept Esophageal Biopsy

Concept Eosinophilic Ascites

Concept Diagnostic Criteria

Distinguished Non-Finalist

Presenter Organization University of Chicago Medicine

Presenting Author Alexandre Zaharia

Track Adult

Keywords

eosinophilic esophagitis

ascites

peripheral eosinophilia

eosinophilic gastrointestinal disease

diarrhea

abdominal distension

jejunal lesion

eosinophilic paracentesis

esophageal biopsy

empiric treatment

Eosinophilic Esophagitis

Esophageal Biopsy

Eosinophilic Ascites

Diagnostic Criteria