Eosinophilic gastroenteritis (EG) is characterized by eosinophilic infiltration of the bowel wall and variable gastrointestinal manifestations. Clinicians should have a high index of suspicion for EG when faced with gastrointestinal symptoms and peripheral eosinophilia to avoid incorrect diagnosis and inappropriate treatments. A 24-year-old woman was admitted to our hospital complaining of acute right lower quadrant abdominal pain and a laparoscopic appendectomy performed for a presumed diagnosis of an acute appendicitis. However, the procedure revealed bowel edema and a moderate amount of ascites without evidence of a suppurative appendicitis. Postoperatively, she showed persistent and progressive eosinophilia, exudative eosinophilic ascites, eosinophilic infiltration of the resected appendix wall, and eosinophilic infiltration of gastroduodenal mucosa. A punch biopsy of the abdominal skin also revealed inflammation with marked eosinophilic infiltration of the skin. She recovered after the treatment with a low dose of steroid for the EG with eosinophilic dermatitis. EG with eosinophilic dermatitis has not been reported yet and is considered fortuitous in this case.
Adult ; Dermatitis/*diagnosis/drug therapy/pathology ; Eosinophilia/*diagnosis/drug therapy/pathology ; Female ; Gastroenteritis/*diagnosis/drug therapy/pathology ; Humans ; Steroids/therapeutic use ; Young Adult

We report a case of early non-invasive diagnosis of acute eosinophilic myopericarditis (AEM) by cardiovascular magnetic resonance (CMR) before cardiac biopsy. A 35-yr-old woman presented with a flu-like illness, followed by pleuritic chest pain and shortness of breath. Transthoracic echocardiography revealed mild left ventricular (LV) systolic dysfunction with borderline LV wall thickness and moderate pericardial effusion. The patient had peripheral eosinophilia and CMR was performed immediately at first day of visit before cardiac biopsy. CMR showed diffuse subepicardial high T2 signals and diffuse late gadolinium enhancement in LV. Steroid therapy was immediately initiated and patient's symptom was rapidly improved. Endomyocardial biopsy at hospital day 3 reported multifocal mild infiltration of eosinophils and lymphocytes. The patient was finally confirmed as acute eosinophilic myopericarditis. This presentation emphasizes on the role of CMR which enables early non-invasive diagnosis of AEM and visualize the extent of the myocarditis.
Adult ; Early Diagnosis ; Echocardiography ; Eosinophilia/*diagnosis ; Female ; Gadolinium/diagnostic use ; Humans ; Magnetic Resonance Imaging ; Pericarditis/*diagnosis/*drug therapy/pathology ; Ventricular Dysfunction, Left/diagnosis/drug therapy/pathology

Adult ; Ascites ; diagnosis ; etiology ; Biopsy ; Diagnosis, Differential ; Duodenal Obstruction ; diagnosis ; etiology ; Endoscopy, Gastrointestinal ; Enteritis ; complications ; drug therapy ; Eosinophilia ; complications ; drug therapy ; Gastritis ; complications ; drug therapy ; Humans ; Intestinal Mucosa ; pathology ; Male ; Tomography, X-Ray Computed

I n some patients, eosinophilic gastroenteritis(EG) occurs in those with food allergy. We experienced a non-atopic asthmatic who had an EG associated with food allergy to fish and eggs, and blood eosinophilia. A skin prick test and RAST to causative food allergens showed a negative result. A fiber-optic endoscopic biopsy from the gastric mucosa showed an intense eosinophilic infiltration. We could find symptomatic improvement and a disappearance of eosinophilic infiltration in gastric mucosa after complete avoidance from the causative food and oral cortcosteroid. It was suggested that fiber-optic endoscopic biopsy might be needed to identify coexisting EG if an allergic patient with blood eosinophilia complains of severe gastrointestinal symptoms.
Adrenal Cortex Hormones/therapeutic use ; Asthma/*complications/drug therapy ; Case Report ; Endoscopy ; Eosinophilia/*complications ; Food Hypersensitivity/*complications ; Gastric Mucosa/pathology ; Gastroenteritis/*complications/diagnosis/pathology ; Human ; Male ; Middle Age

An 82-yr-old man was presented with fever and cough accompanied by generalized erythematous rash. He had taken mexiletine for 5 months, as he had been diagnosed with dilated cardiomyopathy and ventricular arrhythmia. Laboratory studies showed peripheral blood eosinophilia and elevated liver transaminase levels. Chest radiographs showed multiple nodular consolidations in both lungs. Biopsies of the lung and skin lesions revealed eosinophilic infiltration. After a thorough review of his medication history, mexiletine was suspected as the etiologic agent. After discontinuing the mexiletine and starting oral prednisolone, the patient improved, and the skin and lung lesions disappeared. Subsequently, mexiletine was confirmed as the causative agent based on a positive patch test. Drug-induced hypersensitivity syndrome is a severe adverse reaction to drugs and results from treatment with anticonvulsants, allopurinol, sulfonamides, and many other drugs. Several cases of mexiletine-induced hypersensitivity syndrome have been reported in older Japanese males with manifestation of fever, rash, peripheral blood eosinophilia, liver dysfunction without other organ involvement. Here, we report a case of mexiletine-induced hypersensitivity syndrome which presented as eosinophilic pneumonia in a Korean male.
Aged, 80 and over ; Anti-Arrhythmia Agents/*adverse effects ; Arrhythmias, Cardiac/drug therapy ; Cardiomyopathy, Dilated/drug therapy ; Drug Hypersensitivity/*diagnosis/etiology ; Exanthema/pathology ; Humans ; Lung/pathology/radiography ; Male ; Mexiletine/*adverse effects ; Pulmonary Eosinophilia/*chemically induced/*diagnosis ; Syndrome ; Tomography, X-Ray Computed

Kimura's disease (KD) is a rare, chronic inflammatory disorder, which is characterized by tumor-like masses mainly located in the head and neck region. Extraocular muscle involvement in KD is uncommon. We report a case of KD that involved both the extraocular muscles and buccal area. A 13-year-old male presented to our clinic with a two-year history of exophthalmos of the left eye and facial swelling. Facial CT and MRI showed a 1.5 x 1.5 cm2 soft tissue mass located at the left masticator and buccal area, exophthalmos of the left eye, and diffuse thickening of the left extraocular muscles. We performed a lateral rectus muscle incisional biopsy of the left eye. Oral methylprednisolone therapy was initiated and tapered following the incisional biopsy.
Administration, Oral ; Adolescent ; Angiolymphoid Hyperplasia with Eosinophilia/complications/*diagnosis/drug therapy/surgery ; Cheek/*pathology ; Edema/etiology ; Exophthalmos/etiology ; Face ; Glucocorticoids/administration & dosage ; Humans ; Magnetic Resonance Imaging ; Male ; Methylprednisolone/administration & dosage ; Oculomotor Muscles/*pathology/surgery ; Postoperative Care ; Treatment Outcome

Hepatitis A virus (HAV) infections occur predominantly in children, and are usually self-limiting. However, 75-95% of the infections in adults are symptomatic (mostly with jaundice), with the illness symptoms usually persisting for a few weeks. Atypical manifestations include relapsing hepatitis, prolonged cholestasis, and complications involving renal injury. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, drug-induced hypersensitivity reaction characterized by skin rash, fever, lymph-node enlargement, and internal organ involvement. We describe a 22-year-old male who presented with acute kidney injury and was diagnosed with prolonged cholestatic hepatitis A. The patient also developed DRESS syndrome due to antibiotic and/or antiviral treatment. To our knowledge, this is the first report of histopathologically confirmed DRESS syndrome due to antibiotic and/or antiviral treatment following HAV infection with cholestatic features and renal injury.
Acute Kidney Injury/diagnosis ; Anti-Bacterial Agents/*adverse effects/therapeutic use ; Cefotaxime/adverse effects/therapeutic use ; Cholestasis/complications/*diagnosis ; Cytomegalovirus/genetics ; Cytomegalovirus Infections/drug therapy/virology ; DNA, Viral/analysis ; Eosinophilia/etiology ; Exanthema/*chemically induced/pathology ; Ganciclovir/therapeutic use ; Hepatitis A/complications/*diagnosis/drug therapy ; Humans ; Hydrocortisone/therapeutic use ; Immunoglobulins/therapeutic use ; Male ; Syndrome ; Young Adult