Chronic diarrhea, eosinophilic ascites, acute pancreatitis and deep venous thrombosis: A case report

Background: Eosinophilic gastroenteritis (EGE) is a rare inflammatory disease characterized by diffuse eosinophilic infiltration of the gastrointestinal tract with symptoms varying with the location, severity and depth of invasion. Hypereosinophilic syndrome and eosinophilic gastroenteritis overlap considerably in their pathophysiology especially if the latter is early in the clinical course and restricted to the intestinal mucosa alone. Case presentation: A 30 year old male with chronic diarrhea and ascites presented with abdominal pain and acute lower limb swelling. The clinical presentation , peripheral hypereosinophilia and intestinal biopsy findings were all consistent with the diagnosis of EGE with eosinophilic ascites. CT abdomen and doppler imaging of the limb revealed the unusual complication of acute pancreatitis and deep vein thrombosis respectively, occurring simultaneously with EGE, making it a very rare presentation. After managing acute pancreatitis and deep vein thrombosis, the patient was treated with prednisolone 20 mg/day for four weeks and tapered slowly. His diarrhea settled and ascites resolved completely. Conclusion: This case report emphasizes that one should consider these rare disorders during the differential diagnosis of unexplained gastrointestinal symptoms in the presence of hypereosinophilia, encompassing the ‘forme frustes’ of hypereosinophilic syndrome.