Abstract
A 49-year-old woman visited our hospital with chief complaints of nausea, vomiting, stomachache, and diarrhea that had been appearing every few months for 5 years. Computed tomography (CT) showed thickening of the gastric and small intestinal walls, as well as pleural effusion and ascites. The results of clinical tests showed increased levels of peripheral blood leukocytes and eosinophils, and increased eosinophil levels were also seen in ascitic fluid. Esophagogastroduodenoscopy did not show any clear abnormalities, but pathologically, eosinophil infiltration into the mucosa of the esophagus, stomach, and duodenum was observed. Based on these results, eosinophilic gastroenteritis was diagnosed. Treatment with predonisolone (PSL) at 30 mg/day was initiated and resulted in improvement of symptoms as well as decreases in peripheral blood eosinophils, improvement of thickening of the walls of the gastrointestinal tract on CT, and disappearance of pleural effusion and ascites. PSL was discontinued 4 months later because symptoms appeared to have resolved, but recurrence then occurred twice at approximately 1-year intervals, requiring PSL dose increases. At present, the patient is continuing to receive PSL at 2.5 mg/day, with no recurrence for a year. Eosinophilic gastroenteritis cannot be diagnosed based on endoscopic findings alone, and biopsy must be performed. Follow-up is also important, as recurrence can occur even after steroid-induced remission.
