Eosinophilic myenteric ganglionitis presenting with constipation and erythema ab igne: a case report

Background: Eosinophilic myenteric ganglionitis (EMG) is a rarely described and poorly understood cause of functional bowel dysmotility. The condition has been reported in only a few cases as an uncommon pathological basis for the already diagnostically challenging clinical entity of intestinal pseudo-obstruction. Case Description: A 63-year-old woman presented with longstanding, non-specific symptoms of poorly-controlled constipation and abdominal pain in the absence of an acute exacerbating episode, in association with the distinctive clinical sign of erythema ab igne across the abdomen. Following multiple investigations and initial conservative therapy, then colostomy formation, a total proctocolectomy and end-ileostomy was eventually required, with histology confirming EMG. Histologically, EMG is characterized by the presence of an eosinophilic infiltrate within the intestinal myenteric plexus, with or without involvement of surrounding tissues, usually in absence of an associated lymphocytic infiltration or overt neuronal degeneration. This particular presentation with chronic abdominal pain, constipation and the defining feature of an eosinophilic infiltration of the myenteric plexus, and its reporting in other similar cases is what appears to be the cluster of symptoms, signs and pathological abnormality that defines EMG. Conclusions: To date, we know of only ten adult cases of the condition described in the literature, alongside six pediatric cases. While erythema ab igne is in clinical practice a sign usually associated with chronic abdominal pain and hot water bottle use, it is not pathognomonic of any particular pathological entity.