SHM Converge Scientific Abstract ePoster Gallery-More Than Just Stool: A Unique Case of Diarrhea

Pdf Summary

A 50-year-old man with ulcerative colitis, primary sclerosing cholangitis, prior colectomy with ileoanal pouch, and treated disseminated Mycobacterium avium complex presented with one week of severe watery diarrhea, nausea, vomiting, right-sided abdominal pain, pruritus, weakness, and a blanching erythematous chest rash. Symptoms worsened with eating meat. Despite normal vital signs, he had diffuse abdominal tenderness. Labs showed marked leukocytosis and significant eosinophilia (AEC 3,510/μL, later rising to 7,900/μL), mild hyponatremia, and acute kidney injury. Extensive infectious testing, including stool studies, was negative, and CT abdomen/pelvis was unrevealing.<br /><br />Further evaluation showed low IgG but otherwise normal lymphocyte subsets and tryptase. Alpha-gal and Strongyloides IgG testing were negative. Because his abdominal pain, diarrhea, rash, and eosinophilia progressed, endoscopic evaluation was performed. Colonoscopy and enteroscopy revealed patchy erythematous mucosa in the small bowel, and biopsies from the duodenum, ileum, and rectal pouch demonstrated prominent mucosal eosinophilia.<br /><br />He was diagnosed with hypereosinophilic syndrome involving the gastrointestinal tract. Intravenous steroids were started after evaluation for secondary causes, and his symptoms and eosinophilia improved significantly.<br /><br />The case emphasizes that acute diarrhea is usually infectious, but persistent symptoms with rash and eosinophilia should prompt broader consideration of hypereosinophilic syndromes. Tissue biopsy is often needed to confirm organ involvement. It also highlights the importance of excluding Strongyloides infection before giving steroids, since immunosuppression can trigger severe, potentially fatal hyperinfection.

Asset Subtitle

Michael A. Gallagher

Meta Tag

Author List Michael A. Gallagher

Category Clinical Vignettes

Concept Hypereosinophilic Syndrome

Concept Eosinophilia

Concept Hypereosinophilia

Concept Absolute Eosinophil Count

Concept Strongyloides Infection

Distinguished Non-Finalist

Presenter Organization Emory University School of Medicine / Grady Memorial Hospital

Presenting Author Michael A. Gallagher

Track Adult

Keywords

hypereosinophilic syndrome

eosinophilia

gastrointestinal involvement

ulcerative colitis

primary sclerosing cholangitis

diarrhea

rash

endoscopic biopsy

Strongyloides exclusion

steroid therapy

Hypereosinophilic Syndrome

Eosinophilia

Hypereosinophilia

Absolute Eosinophil Count

Strongyloides Infection