Gastro Case Challenge: An Incarcerated 24-Year-Old With Dyspnea, Fatigue, and Chronic Nausea

Nicola E. Burch, MBChB, MRCP; Victoria M. Gordon, MBBS, MRCP


March 18, 2022


The patient was diagnosed with idiopathic eosinophilic gastroenteritis on the basis of the diffuse eosinophilic infiltrate seen on the histologic samples taken from the nodular area of his gastric antrum (Figure 2).

Figure 2.

Eosinophilic gastroenteritis is a rare inflammatory disorder characterized by eosinophilic infiltration of the GI tract, without any known cause of eosinophilia. The gastric antrum and duodenum are primarily involved, but it can also affect the esophagus and colon. It was first described by Kaijser in 1937.[1] Although more than 300 cases have been reported worldwide, the true incidence is unclear. A confounding factor in its characterization is the lack of diagnostic precision.[2]

This condition is an uncommon GI disease that affects adults and children. It usually presents between the third and fifth decades of life; however, it may present in patients of any age. It appears to be slightly more common in white males. A coexistent history of atopy (in approximately 50% of cases), such as asthma (as seen in this case), hay fever, eczema, or food intolerances, is common.

Although the precise underlying pathophysiologic mechanism remains unknown, the most widely accepted theory involves mast cell activation by possible allergenic insult, leading to histamine and cytokine release, which causes eosinophil activation. Allergens (eg, food, virus, immunoglobulin) initially enter the GI tract via the compromised integrity of the gut mucosa. The subsequent activation of eosinophils by the allergen leads to the release of platelet-activating factor, histamines, toxic proteins, and leukotrienes, which results in mucosal damage and inflammation. Few reports have described death resulting from this condition; however, malnutrition and intestinal perforation may be seen.[2,3,4,5,6,7]

The time between the initial presentation and the diagnosis may be months or years, as a result of the broad spectrum of presenting symptoms. The fact that the presenting features may overlap with those of other, more common underlying GI diseases (such as inflammatory bowel disease) can lead to misdiagnosis and unnecessary therapy.[2,4]


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