Eosinophilic Abscess of the Small Intestine in Treatment-Resistant Transmural Eosinophilic Gastroenteritis

In patients with treatment-resistant transmural eosinophilic gastroenteritis, a submucosal eosinophilic abscess may be an important pathologic finding.

A 19-year-old woman was seen for a 10-month history of abdominal pain, nausea, vomiting, poor appetite, weight loss, unresponsive to oral cromolyn sodium, H2 receptor blockers, and proton pump inhibitors, anticholinergics, and hyperalimentation.  Endoscopic small bowel biopsy showed no evidence for Campylobacter, Giardia, Whipple’s disease, granulomas, or malignancy. The peripheral eosinophil count was initially normal. The serology for parasites was negative. Bone marrow showed increased eosinophil numbers. The antrum of the stomach, duodenum, jejunum, and ileum was all normal in appearance. Small bowel x-ray showed a diffuse abnormality of the jejunum with an increased number of folds and a very slight increase in thickness.  Because of eosinophilia (24%) and continued symptoms, she underwent laparotomy with resection of a 10 cm section of the small bowel, mesentery, and lymph nodes (Figure 1). 

A dense submucosal eosinophilic abscess and full-thickness involvement by eosinophilic gastroenteritis (EGE) were found (Figure 2). Prednisone administration was not symptomatically effective.

She was then seen at our clinic, where CT scan of the abdomen/pelvis and proctologic exams were normal. Enteroclysis demonstrated some crowding of the folds in the jejunum. She returned home and was lost to follow-up. 

Eosinophilic abscess, not previously been reported in EGE, can accompany the resistant transmural disease [1,2].

Conflicts of Interest: Neither author has a conflict of interest to declare.

Author Contribution: Both authors contributed equally to the creation of this manuscript.

Funding source: None.

IRB: This research was approved by the Mayo Clinic IRB.

1. Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS, et al. Eosinophilic gastroenteritis: 10 years experience. The american journal of gastroenterology. 1993;88(1):70–74.
2. Talley NJ, Shorter RG, Phillips SF, Zinsmeister AR. Eosinophilic gastroenteritis: A clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues. Gut. 1990;31(1):54–58.

Small intestine; Eosinophilic gastroenteritis; Eosinophilic abscess

Butterfield JH, Graham RP. Eosinophilic abscess of the small intestine in treatment-resistant transmural eosinophilic gastroenteritis. Clin Case Rep J. 2020;1(6):1–2.

© 2020 Joseph H. Butterfield. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY-4.0).