Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2018; 6(7): 156-160
Published online Jul 16, 2018. doi: 10.12998/wjcc.v6.i7.156
Massive hemorrhagic ascites: A rare presentation of eosinophilic gastroenteritis
Lei Shi, Qiu-Hong Jia, Fu-Jian Liu, Hang Guan, Zhi-Yong Jiang
Lei Shi, Qiu-Hong Jia, Fu-Jian Liu, Hang Guan, Zhi-Yong Jiang, Department of Gastroenterology, the Eighth Affiliated Hospital of Guangxi Medical University, Guigang 537100, Guangxi Zhuang Autonomous Region, China
Author contributions: Shi L conceived and coordinated the study, and participated in data collection, and manuscript writing; Jia QH participated in the study design, data collection, production of histopathological figures, and manuscript writing; Liu FJ, Guan H and Jiang ZY participated in data collection and manuscript writing.
Informed consent statement: Informed consent was obtained from the patient.
Conflict-of-interest statement: The authors declare no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lei Shi, MD, PhD, Doctor, Department of Gastroenterology, the Eighth Affiliated Hospital of Guangxi Medical University, No. 1 Zhongshan Road, Guangxi 537100, Guangxi Zhuang Autonomous Region, China. ycymoment@hotmail.com
Telephone: +86-775-4200028 Fax: +86-775-4200028
Received: February 15, 2018
Peer-review started: February 19, 2018
First decision: March 12, 2018
Revised: May 2, 2018
Accepted: May 30, 2018
Article in press: May 30, 2018
Published online: July 16, 2018
Abstract

According to Klein’s classification system, the symptomatology of eosinophilic gastroenteritis (EG), a rare disease, differs based on the affected tissue layer. Patients with subserosal EG often have peritoneal effusion. Hemorrhagic ascites due to EG is extremely rare and has not been reported in the literature. Here, we report a 57-year-old woman with EG and massive hemorrhagic ascites. Laboratory investigations showed elevated peripheral eosinophils with significant eosinophilia (65.6%). Ultrasonography showed massive abdominal ascites. Abdominal paracentesis revealed hemorrhagic peritoneal fluid and microscopy showed predominant eosinophils. Upper gastrointestinal endoscopy revealed erosions, exudates, and mucosal rings in the duodenal mucosa; histological examination indicated eosinophilic infiltration. EG presenting with hemorrhagic ascites was diagnosed by histologic examination of eosinophilic infiltration. She was empirically treated with ketotifen 1 mg bid po with rapid resolution of ascites and a remarkable decline in peripheral eosinophil counts. Clinicians should consider the differential diagnosis of unexplained hemorrhagic ascites.

Keywords: Hemorrhagic ascites, Eosinophilic infiltration, Eosinophilic gastroenteritis

Core tip: Eosinophilic gastroenteritis (EG) with ascites is extremely rare. We report a 57-year-old woman with EG and massive hemorrhagic ascites who underwent endoscopy and abdominal paracentesis. Differential diagnoses included other causes of tissue eosinophilia. The patient was in good condition 1 year after drug therapy with no recurrence of ascites and gastrointestinal symptoms. To our knowledge, this is the first report of a rare case of massive hemorrhagic ascites in EG. Clinicians should consider the differential diagnosis of unexplained hemorrhagic ascites, especially in patients with gastrointestinal mucosa lesion, peripheral eosinophilia, and ascites.