Abstract Text: Eosinophilic gastrointestinal diseases (EGIDs) are rare inflammatory conditions marked by eosinophil-predominant inflammation in the gastrointestinal tract. Eosinophilic colitis, a type of EGID, often presents with nonspecific symptoms such as abdominal pain, diarrhea, and weight loss. Due to the rarity of EGIDs, early recognition and treatment is particularly challenging.
A 37-year-old woman with asthma presented with intermittent abdominal pain and non-bloody diarrhea. She was recently hospitalized for a severe asthma exacerbation that required intubation, though she made a full recovery. Laboratory studies revealed marked eosinophilia (AEC 3.6 x10⁹/L, 82%), elevated IgE (1759), and mild CRP elevation (1.01). Imaging showed small bowel enteritis and pancolitis. Stool studies and infectious workup were negative. Targeted biopsies revealed pronounced eosinophilia in the colon, including focal abscess formation and crypt epithelial infiltration.
The patient received IV solumedrol with rapid symptom resolution, normalization of eosinophilia, and symptomatic improvement. She was transitioned to oral prednisone with continued symptom control.
This case highlights eosinophilic colitis as a rare, but significant consideration in patients with atopic diseases presenting with unexplained GI symptoms. IV corticosteroids followed by an oral taper led to significant clinical improvement, though the optimal steroid dose and taper duration remain uncertain given the infrequency of eosinophilic colitis. Given the patient’s history of asthma, biologics may provide alternative treatment options for long-term management rather than steroids. Identifying unusual presentations of EGIDs allows for early diagnosis and effective treatment as well as adding to the limited literature on this disease.
