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Perplexing case of abdominal pain with eosinophilia and fasciitis
  1. Robert Sean O'Neill1,2,
  2. Logan Gardner3,4,
  3. Anthony Kelleher3,5,
  4. Roger Pamphlett6,7,
  5. Laila Girgis1,8,
  6. Alina Stoita1,2
  1. 1School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  2. 2Department of Gastroenterology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
  3. 3Department of Immunology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
  4. 4Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  5. 5The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
  6. 6Department of Neuropathology, Royal Prince Albert Hospital, Camperdown, New South Wales, Australia
  7. 7Brain and Mind Centre, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  8. 8Department of Rheumatology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
  1. Correspondence to Dr Robert Sean O'Neill, School of Medicine, University of New South Wales, Sydney, Australia; robert.oneill{at}svha.org.au

https://doi.org/10.1136/gutjnl-2024-332580

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    Clinical presentation

    A 34-year-old man presented to our institution for review with recurrent abdominal pain, constipation, lethargy, fevers and episodic migratory soft tissue severe cellulitis of the limbs after minimal exercise. This was on a background of a diagnosis of eosinophilic enterocolitis at the age of 10 when due to recurrent abdominal pain, endoscopy was performed with biopsies showing eosinophilic infiltration of the oesophagus, stomach, duodenum and colon. This had been treated with steroids in the past with clinical response. A variety of disease-modifying antirheumatic drugs (DMARDs) failed to provide a steroid-sparing effect previously. Clinical history was otherwise significant for resolved childhood asthma and eczema.

    The patient underwent a gastroscopy and colonoscopy which demonstrated oesophageal (figure 1A), stomach, duodenal and terminal ileal eosinophilic infiltration, along with pancolitis on colonic …

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    Footnotes

    • Contributors Manuscript preparation and writing: LG, RSO, AK, AS, LG and RP. Collection of data: RSO, AS, RP and LG. Writing and final approval of manuscript: AS, AK and LG.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.