SHM Converge Scientific Abstract ePoster Gallery-Eosinophilic Gastritis Presenting With Acute Gastric Perforation: A Rare Surgical Emergency

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This case describes a 76-year-old woman with ESRD on hemodialysis, coronary artery disease, and asthma who presented with 2 weeks of diffuse pruritic rash, progressive postprandial abdominal pain, and toe pain/numbness. Exam showed a patchy maculopapular rash, epigastric tenderness, and weak distal pulses. Labs revealed leukocytosis, marked eosinophilia, and anemia. Infectious, autoimmune, and parasitic workup was negative.<br /><br />Imaging demonstrated extensive ulcerated aortic plaque with mobile embolic material and severe multibed arterial stenoses, consistent with diffuse atheroembolic disease. She was treated with IV methylprednisolone and diphenhydramine, with rapid improvement in abdominal pain and a sharp drop in eosinophils, though counts later fluctuated. Topical steroids partially improved the rash.<br /><br />On hospital day 10, she developed melena. Endoscopy showed erosive gastritis and a prepyloric ulcer. Shortly afterward, she acutely worsened with abdominal distention, severe pain, elevated lactate, metabolic acidosis, colonic dilation, and repeat imaging showing pneumoperitoneum from bowel perforation. Because of her comorbidities, she was not a surgical candidate and was transitioned to comfort care; she subsequently died.<br /><br />The report highlights eosinophilic gastritis, a rare eosinophilic gastrointestinal disorder characterized by eosinophil-predominant gastric inflammation without secondary causes. Symptoms are often nonspecific, but transmural disease can lead to ulceration and, rarely, perforation. Corticosteroids are typically first-line and often effective, as suggested by this patient’s transient response.<br /><br />This case is notable because diffuse atheroembolic disease complicated the presentation and could also explain rash, abdominal pain, and eosinophilia. The authors emphasize that clinicopathologic correlation is essential, biopsies may miss patchy disease, and early recognition is critical because medical therapy may not prevent catastrophic perforation once transmural injury occurs.

Asset Subtitle

Tina Kana

Meta Tag

Author List Hehui Quan, Lara Seder, Nadine Aboukaff, Oluwabunmi Aruleba, Saul Kruger, Tina Kana, Vladimir Ornstein

Category Clinical Vignettes

Concept Eosinophilic Gastritis

Concept Secondary Cause

Concept Abdominal Pain

Concept Biopsy

Concept Eosinophilic Disorder

Distinguished Non-Finalist

Presenter Organization Lenox Hill Hospital

Presenting Author Tina Kana

Track Adult

Keywords

eosinophilic gastritis

atheroembolic disease

hemodialysis

pruritic rash

eosinophilia

abdominal pain

bowel perforation

corticosteroid therapy

gastric ulcer

colonic dilation

Eosinophilic Gastritis

Secondary Cause

Abdominal Pain

Biopsy

Eosinophilic Disorder