Total Pageviews

Tuesday, 2 September 2014

CASE 272: EOSINOPHILIC GASTROENTERITIS and ASCITIS , Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Patient 42 yo, labor of the load of bread, one  month ago  complaint by  periumbilical pain crisis.durring 1-2  minutes, no  fever  no  diarrhea,   more and  more frequent.
Ultrasound  abdomen  first time detected  free fluid ascitis in  large amount of volume  but unknown origine (see  ultrasound  images).




Gastroendoscopy showed gastritis with  negative HP test,



MSCT no CE also made sure this  liver  no cirrhosis and ascitis unknown origine.






Blood test report = WBC  rising.





What is your  diagnosis for the case and what do you do next ? 




Ultrasound guided punction of ascitis which was removed the yellowish  clear fluid  and biochemistry and cytology analysis.



RECENTLY LAB  REPORT of  BLOOD TEST from THIS PATIENT.


DISCUSSION:

 This case  was represented unknown  ascitis  at first  time by  ultrasound and CT scan, and blood test  report was  eosinophil  rising  too much,  43%, that many doctors were looking for a  parasite infected cause.
But, ascitis  analysis was  transudate fluid  and hypoalbumine,   while  CA125  was very high, of 1380 UI/mL  in the male patient. So it was  difficult to explain that.

Cytology of  ascitis fluid  showed  that  many  white blood cells  of eosinophil  in  one staining microscopic champ.
Second report  of blood test today  ruled out parasite infection, but IgE very high,  of  1168 UI/mL, that  suggested an  eosinophylic gastroenteritis.


For  review and  make sure  this  diagnosis, an other  ultrasound scanning of  abdomen perfomed  to  detect   thickening of  intestine wall.  And  cytology  smear of ascitis  fluid  was more eosinophil cells. 

A course of  corticotherapy was started today. Wait for  clinical response.

After 2 days treatment with 50mg prednisolone, the blood test spectacularly responsed.





Today 9/9/2014

Update case 272:  After one week treated with corticoid,  clinical status of the patient remains well in recovery.
Ultrasound of abdomen  shows  completetly  dissapearing ascitis  ans blood test returns  nearly to  normal values ( see 2 ultrasound images, and blood test report).





REFERENCE:



2 comments :

Hong Anh said...

eosinophilic gastroenteritis

Hong Anh said...

Multiple therapeutic strategies have been tried in order to avoid steroid side effects with long term treatment (available in Việt nam with reasonal cost):
- Enteric coated budesonide
- sodium cromoglycate
- Montelucast, a leukotriene receptor inhibitor
Other promising medicine : Omalizumab and mepolizumab ( anti-Ig-E and anti-IL-5 monoclonal antibodies )