S3715 Eosinophilic Gastroenteritis Presenting With Eosinophilic Ascites: A Case of a Unique Finding of a Rare Disease

Introduction: Eosinophilic gastroenteritis (EGE) is part of a group of conditions known as eosinophilic gastrointestinal disorders (EGID), the most common of which is eosinophilic esophagitis (EoE). In the literature, EGE typically refers to a syndrome characterized by gastrointestinal (GI) symptoms and eosinophilic infiltration (EI) of the GI tract outside of the esophagus. It can be further classified into eosinophilic gastritis, enteritis, and colitis based on the affected region. With around 300 cases reported worldwide, EGE is relatively rare and understudied making incidence and prevalence unclear. Current knowledge is largely derived from case reports and case series. Along with typical nonspecific signs and symptoms of GI illness often seen with viral gastroenteritis, 1 well documented sign of EGE is ascites with an eosinophilic predominance on fluid cell count and differential, though this is typically seen with serosal involvement of the GI tract. Case Description/Methods: We present a case of a 28-year-old man with no known past medical history, originally from India, who presented with several days of abdominal symptoms, and was found to have new onset ascites. On presentation the patient was found to have marked eosinophilia on complete blood count as well as significant eosinophilia in his ascites. Endoscopy workup showed gross signs of esophagitis and biopsy was equivocal for EoE. Colonoscopy was grossly normal but showed marked eosinophils in the muscularis mucosa throughout the colon and terminal ileum on biopsy. Small bowel wall enhancement was also seen on imaging suggestive of enteritis. The patient also underwent liver and bone marrow biopsy, and extensive infectious workup which were all negative. He was treated with systemic corticosteroids and had improvement of symptoms and resolution of his ascites at follow up. Discussion: Along with showcasing an interesting presentation and pattern of GI tract involvement, this case underscores the importance of a thorough evaluation for new-onset eosinophilic ascites, including ruling out other potential causes such as infection (particularly tuberculosis in this case), malignancy, liver disease, or other inflammatory conditions. However, despite the rarity of EGE, clinicians should remain aware of it being in the differential in the right clinical context, especially since treatment is both cost effective and efficacious based on prior case reports and in the case of our patient as well.