doi: 10.5505/abantmedj.2013.69772 Abant Medical Journal Olgu Sunumu / Case Report Volume Cilt 2 Issue Sayı 2 Year Yıl 2013 İletişim Bilgisi / Correspondence 151 Uzm. Dr. Uğur Korkmaz, Department of Gastroenterology, Kocaeli University Medical Faculty 41300 Kocaeli - Türkiye E-mail: drkorkmazugur@yahoo.com Tel: +90 262 3037383 Geliş tarihi / Received: 11.05.2013 Kabul tarihi / Accepted: 19.06.2013 Çıkar Çatışması / Conflict of Interest: Yok / None Eosinophilic Gastroenteritis with Serosal Involvement and Cyclic Neutropenia Serozal Tutulumlu Eozinofilik Gastroenterit ve Siklik Nötropeni Uğur Korkmaz 1 , Ali Erkan Duman 1 , Neslihan Bozkurt 1 , Gökhan Dindar 1 , Hasan Yılmaz 1 , İlhan Dolaşık 2 , Mürsel Sali 2 , Burak Can 2 , Altay Çelebi 1 , Ömer Şentürk 1 , Sadettin Hülagü 1 1 Kocaeli Üniversitesi Tıp Fakültesi, Gastroenteroloji Bilim Dalı, Kocaeli 2 Kocaeli Üniversitesi Tıp Fakültesi, İç Hastalıkları Ana Bilim Dalı, Kocaeli Özet Abstract Eozinofilik gastroenterit gastrointestinal kanalın farklı alanla- rının eozinofilik infiltrasyonuna bağlı olarak farklı klinik tablo- ların görüldüğü nedeni bilinmeyen bir hastalıktır. Eozinofilik gastroenteritin seyrinde görülen hematolojik bulgu sadece eozinofilidir. Biz eozinofilik gastroenterit ve eozinofilik asit nedeniyle değerlendirilen ve siklik nötropeni görülen bir hastayı sunduk. Her ne kadar siklik nötropeni solid organ veya hematolojik malignensileri desteklerse de steroid teda- visi ile asit, nötropeni ve periferal eozinofilide düzelme olması tablonun eozinofilik gastroenterite bağlı olduğunu doğrulamıştır. Eozinofilik gastroenteritin seyrinde siklik nötropeni görülebileceği akılda tutulmalıdır. Eosinophilic gastroenteritis is a disease of unknown etiology presenting with different clinical pictures due to eosinophilic infiltration of different areas in gastrointestinal tractus. Eosinophilia is the sole hematologic finding seen in the course of eosinophilic gastroenteritis. We presented a case evaluated for eosinophilic ascites and diagnosed as eosinop- hilic gastroenteritis in which cyclic neutropenia was seen. Although cyclic neutropenia suggests solid organ or hemato- logic malignancy no sign of malignancy on investigations, improvement in ascites, peripheral eosinophilia and neutro- penia with steroid therapy confirmed that this picture was completely due to eosinophilic gastroenteritis. It should be kept in mind that cyclic neutropenia may be seen during the course of eosinophilic gastroenteritis. Anahtar Kelimeler: eozinofilik gastroenterit, eozinofilik assit, siklik nötropeni, eozinofili, serozal tutulum. Keywords: eosinophilic gastroenteritis, eosinophilic ascites, cyclic neutropenia, eosinophilia, serosal involvement. Introduction Eosinophilic gastroenteritis (EG) is a rare clini- cal entity characterised with gastrointestinal symptoms (GIS), peripheral eosinophilia when there is no other explanation for eosinophilia, eosinophilic infiltration and no involvement in other organ systems (heart, brain, kidney etc.). Clinical picture may vary with the layer of the gastrointestinal tract (e.g. mucosal, muscular, and serosal) involved. Eosinophilic ascites is the typical finding of serosal involvement (1). In this article we will discuss an EG case who presented with eosinophilic ascites. Case Report A 28-old male was admitted to the hospital with the complaints of abdominal pain and distension lasting for a month. His medical history was unremarkable. On physical exami- nation mild abdominal distension with positive fluid sign was noted but there was no periph- eral edema. No other positive physical exami- nation finding could be noted. Laboratory find- ings revealed leucocytosis (marked peripheral eosinophilia) and an elevated IgE level (292 kU/l, normal value < 100 kU/l). Laboratory and clinical findings are shown on Table–1. Ultra- sonographic examination revealed moderate ascites. No finding suggesting portal hyperten- sion, liver or renal abnormality could be de- tected. Abdominal paracentesis yielded exuda- tive fluid with a serum-ascites albumin gradi- ent of 0.6 mg/dl, white blood count of 1319 cells/mm³( 6% neutrophils, 4% lymphocytes, 90% eosinophils ( figure 1) ) and negative cul- tures. Computerized tomographic (CT) scan of abdomen showed ascites, extensive peritoneal mass and marked wall thickening of distal esophagus and the jejenum. Figure 1. Eosinophilia in ascites fluid (Giemsa x 1000)