A Rare Case Report of Primary Eosinophilic Colitis

Eosinophilic enterocolitis is the rarest form in primary eosinophilic gastrointestinal
disease (EGID) without other causes of eosinophilia. There are few described cases
in the literature. We reported a rare case of eosinophilic colitis, where a 35-year-old
woman presented to us with chronic diarrhoea associated with abdominal pain and
rectal bleeding for 6 months. She had features of unspecific colitis and significant
eosinophilia with the colonic biopsy reported. Diarrhoea was resolved with a course
of corticosteroid. No complications or recurrences were reported. In conclusion,
Eosinophilic colitis is rarely reported. Eosinophilic colitis ethology and pathogenesis is
unknown. Its clinical, endoscopic and imaging features are not specific. However, this
could be underdiagnosed. All chronic diarrhoea cases should be offered colonoscopy
with biopsy to rule out Eosinophilic Colitis.


Introduction
Eosinophilic gastrointestinal disorder is characterized by eosinophilic infiltrates along the gastrointestinal tract without any other cause such as drug reactions, parasitic infections or malignancies [1]. Eosinophilic gastrointestinal disorders include eosinophilic esophagitis, eosinophilic gastroenteritis and eosinophilic colitis, with eosinophilia. acidosis is the rarest form.
Most cases of primary eosinophilic colitis are idiopathic. Secondary eosinophilic infiltrates in the colon wall can be caused by a variety of causes, such as parasitic infections, medications or enteritis disease. Therefore, the diagnosis of primary eosinophilic colitis is an excluded diagnosis. This is a rare condition with an unclear pathogenetic mechanism and a poor response to treatment. There have been rarely case reports of eosinophilic colitis. To date, about 52 cases have been reported in the world [2]. We have reported a case of eosinophilic colitis in 34-year-old women successfully treated with corticosteroids. Our report aims to raise clinicians' awareness of eosinophilic colitis that may appear as chronic diarrhoea and require corticosteroid treatment.

Case Report
A 34-year-old female patients with a history of diarrhoea who had been treated for more than 6 months but did not reduce,

f) HIV test was negative.
Eosinophilic enterocolitis is the rarest form in primary eosinophilic gastrointestinal disease (EGID) without other causes of eosinophilia. There are few described cases in the literature. We reported a rare case of eosinophilic colitis, where a 35-year-old woman presented to us with chronic diarrhoea associated with abdominal pain and rectal bleeding for 6 months. She had features of unspecific colitis and significant eosinophilia with the colonic biopsy reported. Diarrhoea was resolved with a course of corticosteroid. No complications or recurrences were reported. In conclusion, Eosinophilic colitis is rarely reported. Eosinophilic colitis ethology and pathogenesis is unknown. Its clinical, endoscopic and imaging features are not specific. However, this could be underdiagnosed. All chronic diarrhoea cases should be offered colonoscopy with biopsy to rule out Eosinophilic Colitis. g) Stool culture was negative, hidden blood in stool positive.

h) Abdominal ultrasound only records mild fatty liver.
Endoscopy in most eosinophilic colitis shows normal colon mucosa, which helps distinguish it from other forms of colitis.
Nonspecific endoscopy results, such as mucosal edema, regional hyperaemia, and other lesions such as granular mucosa and aphthous ulcers can be seen, although these features are uncommon and not should rely on for diagnosis [3]. Results of biopsy of the colon mucosa show that the colon lining with normal gland or benign hyperplasia with permeability of chronic inflammatory cells in the stroma, there are many eosinophils (Figure 1).

Discussion
The pathophysiology of eosinophilic colitis is still unknown. Primary eosinophilic colitis may be due to an Th2 lymphoidmediated immune response in adults. IL-3, IL-5 and IL-13 and granulocyte macrophage stimulation factor (GM-CSF) may play an important role in eosinophil infiltrates into colon tissue [1]. The diagnosis of primary eosinophilic colitis is a diagnosis that excludes secondary causes with three signs: peripheral eosinophilia, eosinophil infiltrates in the colon and chronic diarrhoea [4]. Our patients met diagnostic criteria with chronic diarrhoea, peripheral eosinophilia, and histopathological findings of dense eosinophilia in the colon. Diarrhoea symptoms and eosinophilia improved with corticosteroids. The patient was clinically relieved and did not relapse despite discontinuation of corticosteroids for 6 months.
Eosinophilic colitis in adults tends to be chronic. There were no randomized controlled trials in the treatment of eosinophilia, all data drawn from case reports and small cases [5]. There is only unique evidence associated with the use of montelukast in eosinophilic duodenitis [6].
Currently, the treatment for primary eosinophilic colitis is primarily based on case reports and expert opinion. There are no guidelines for the treatment of primary eosinophilia. In general, treatment is based on the presence and stability of symptoms.
Dietary changes are often ineffective in adults. Corticosteroids are the most effective symptom control tool, helpful in most cases.
The efficacy of corticosteroids for eosinophilic disorders is largely mediated by inhibiting eosinophil growth factors such as IL-3, IL-5 and GM-CSF [7]. The drug is often used in the same doses as those used for inflammatory bowel disease and localized budesonide can avoid systemic side effects. Corticosteroid treatment is usually recommended, in which most patients will respond within two weeks at a dose of 20-40mg per day. Although, doses higher than 0.5 -1 mg / kg / day have also been noted in some reports [8].