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Eosinophilic Colitis, an Uncommon Cause of Diarrhea: Case Report and Literature Review.

ABSTRACT: Eosinophilic colitis and hypereosinophilic syndrome with colic involvement are rare diagnosis that are characterized by wide-ranging gastrointestinal symptoms and idiopathic infiltration of eosinophils in the colon. The diagnostic workup is challenging since there are no standardized criteria. We report a case of a man admitted to the hospital with a history of nonbloody chronic diarrhea. The detailed workup demonstrated blood eosinophilia, and the colonic biopsies revealed extensive eosinophilic infiltration. He was treated with steroids with clinical and analytical improvement. Due to relapsing colitis after therapy withdrawal, he was chronically medicated with 10 mg of prednisolone with ultimate symptom control. This case report describes the diagnostic workup and highlights the most important features of this often underdiagnosed entity.

SUBMITTER: Cardoso P

PROVIDER: S-EPMC10661707 | biostudies-literature | 2023 Nov

REPOSITORIES: biostudies-literature

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Eosinophilic Colitis, an Uncommon Cause of Diarrhea: Case Report and Literature Review.

Cardoso Pedro P Elias Catarina C Medas Renato R Cardoso Leila L Peixoto Armando A Macedo Guilherme G Almeida Jorge J

GE Portuguese journal of gastroenterology 20221221 Suppl 2

Eosinophilic colitis and hypereosinophilic syndrome with colic involvement are rare diagnosis that are characterized by wide-ranging gastrointestinal symptoms and idiopathic infiltration of eosinophils in the colon. The diagnostic workup is challenging since there are no standardized criteria. We report a case of a man admitted to the hospital with a history of nonbloody chronic diarrhea. The detailed workup demonstrated blood eosinophilia, and the colonic biopsies revealed extensive eosinophili ...[more]

PMID: 38020823

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Project description:BACKGROUND:Patients with end-stage kidney disease (ESKD) most commonly complain of gastrointestinal symptoms, such as diarrhea. Diarrhea negatively affects patient quality of life and has miscellaneous etiologies, such as Clostridium difficile-associated diarrhea (CDAD) and ischemic colitis. However, it is sometimes extremely difficult to determine the true etiology given the comorbidities and complications the patients have. A rare cause of diarrhea is ulcerative colitis (UC), which commonly affects the rectum and proximal colon in a continuous fashion. UC with rectal sparing or segmental distribution, although atypical, sometimes leads to misdiagnosis. Herein, we present a case of UC in a patient on hemodialysis with intractable diarrhea; we initially considered that the diarrhea was caused by CDAD and ischemic colitis. CASE PRESENTATION:A 69-year-old man with a history of hypertension, bilateral thalamic hemorrhage, and decreased kidney function was admitted to our hospital because of congestive heart failure. Volume control was impossible due to renal dysfunction and he was started on hemodialysis. Thereafter, he received various antibiotics for bacterial infections. Simultaneously, he experienced continuous watery, and sometimes bloody, diarrhea, which was diagnosed as CDAD owing to a positive stool test for Clostridium difficile toxins. Antibiotic treatment for CDAD did not result in symptom relief. Subsequently, we performed colon biopsy via colonoscopy, and the pathology showed virtually no inflammation with rectal sparing and segmental distributions. These findings favored the presence of ischemic colitis due to arteriosclerosis and ESKD rather than infections. He died of cardiac arrest before the diarrhea was alleviated. Finally, UC was revealed on autopsy as the main cause of the uncontrollable diarrhea. CONCLUSIONS:Patients with ESKD have a greater risk of developing CDAD and ischemic colitis, which have clinical features that sometimes overlap with those of UC, as in the present case. This case emphasizes the importance of correctly diagnosing the etiology of intractable diarrhea and the fact that other diarrhea etiologies can obscure the existence of inflammatory bowel disease, which should be considered and treated properly when patients on hemodialysis present with intractable diarrhea.

Project description:Examination of host genome-wide changes upon encounters with pathogens provides insight into the pathogenesis of infection and disease. When performed comparatively, it may shed light on the mechanisms underlying host susceptibility. In this study, gene expression in the mouse colon was investigated in two cognate lines of mice that differ in their response to Citrobacter rodentium infection; susceptible inbred FVB/N (FVB) and resistant outbred Swiss Webster (SW) mice. Gene expression in the distal colon was investigated prior to infection and at 4 and 9 days post-inoculation using a whole mouse genome Affymetrix array. Computational analysis identified 462 (1%) probe sets differentially expressed by more than 2-fold between uninoculated SW and FVB mice. In response to C. rodentium infection, 5,123 probe sets (11.4%) were significantly modulated in one or both lines of mice. Microarray data were validated by quantitative real time RT-PCR on 35 selected genes (r = 0.87, p < 0.001) and were found to have a 94% concordance. Transcripts represented by 1,547 probe sets (3.4%), were differentially expressed between FVB and SW mice regardless of infection status (host effect). Genes associated with transport were over-represented to a greater extent than immune response-related genes (25% vs. 11% of enrichment, respectively). Electrolyte analysis revealed hypochloremia and hyponatremia in susceptible animals. The results support the hypothesis that mortality in C. rodentium-infected FVB mice is associated with impaired ion transport and development of fatal hypovolemia. These studies contribute to our understanding of the pathogenesis of C. rodentium and suggest novel strategies for the prevention and treatment of diarrhea associated with bacterial infections of the intestinal tract. Experiment Overall Design: Global gene expression analysis was performed on the distal colon with 2-3 mice per group. Because no difference for any parameters was observed in uninfected mice at 4 or 9 dpi, the animals were pooled into an uninoculated control groups for each line of mouse. The selection of representative samples for microarray analysis was based on known infection status and colonic lesions. The final number of biological replicates for each condition was n = 5 for uninoculated FVB mice (âFpâ group), n = 4 for uninoculated SW mice (âSpâ group), and n = 3 for infected animals from each line at each time point (âFi4â, âSi4â, âFi9â, and âSi9â respectively).

Project description:Introdução Há evidências da associação da gravidade da COVID-19 com níveis séricos elevados da interleucina-18 (IL-18), as variantes genéticas desta citocina podem influenciar sua expressão e níveis séricos, contribuindo para a gravidade da COVID-19, há poucos estudos que correlacionam os polimorfismos genéticos da IL-18 com a gravidade desta doença, por isso buscamos contribuir para a compreensão da heterogeneidade clínica e desfecho em uma amostra da população brasileira de pacientes com COVID-19. Objetivo Avaliar a associação dos polimorfismos no gene da IL-18 com a gravidade clínica e desfecho da COVID-19 em uma amostra do estado do Paraná (PR). Método O estudo incluiu 158 pacientes de ambos os sexos, que recorreram ao serviço de atendimento hospitalar no período de junho a novembro de 2020 e que testaram positivo para SARS-CoV-2/RT-PCR+. Foram incluídos pacientes advindos da Universidade Estadual do Centro Oeste (UNICENTRO) de Guarapuava; da Universidade Estadual de Londrina (UEL) em Londrina e da Pontifícia Universidade Católica do Paraná (PUCPR) em Curitiba. As análises moleculares foram realizadas no Instituto para Pesquisa do Câncer (IPEC) de Guarapuava - PR. A coorte foi composta por 3 grupos e a estratificação dos casos foi feita por gravidade, conforme critérios estabelecidos pela Organização Mundial da Saúde. Resultados Avaliamos as variantes da IL-18 associados a gravidade da COVID-19 (casos leves x casos moderados e graves) e obtivemos os seguintes polimorfismos: rs360721 (alelos: C/G /freq: 0.22/ OR 1.603 (0.849; -3.026)/p: 0.1456), rs549908 (alelos: G/T /freq: 0.22/ OR 1.285 (0.6617; -2.496)/p: 0.4588), rs45497197 (alelos: T/C /freq: 0.01/ OR 0.2173 (0.01918; -2.463)/p: 0.2179), rs147751347 (alelos: T/G /freq: 0.02/ OR 1.532 (0.3591; -6.539)/p: 0.5643), rs141025779 (alelos: A/G / freq: 0.02/ OR 1.657 (0.3826; - 7.178)/ p: 0.4994), rs4988359 (alelos: C/T / freq: 0.14 / OR 1.166 (0.5261; -2.584)/p: 0.7052). Consideramos também a associação entre o desfecho clínico (recuperados x óbitos), neste cenário encontramos apenas uma variante: rs549908 (alelos: G/T / freq: 0.22 / OR 0.2556 (0.08; - 0.78)/p: 0.01757). Conclusão Esses achados sugerem que a variante do gene da IL-18, rs549908, está associado ao desfecho clínico da COVID-19 e que são necessários mais estudos para avaliar importância das variantes genéticas do gene da IL-18 como marcadores de prognóstico na doença. Ag. Financiadora Fundação Araucária.

Dataset Information

Eosinophilic Colitis, an Uncommon Cause of Diarrhea: Case Report and Literature Review.

Publications

Eosinophilic Colitis, an Uncommon Cause of Diarrhea: Case Report and Literature Review.

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