Case Report
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World J Gastroenterol. Nov 21, 2014; 20(43): 16368-16371
Published online Nov 21, 2014. doi: 10.3748/wjg.v20.i43.16368
Fecal microbiota transplantation and prednisone for severe eosinophilic gastroenteritis
Yi-Xuan Dai, Chuan-Bing Shi, Bo-Ta Cui, Min Wang, Guo-Zhong Ji, Fa-Ming Zhang
Yi-Xuan Dai, Chuan-Bing Shi, Bo-Ta Cui, Min Wang, Guo-Zhong Ji, Fa-Ming Zhang, Department of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
Author contributions: Dai YX wrote the paper; Shi CB performed the pathological work; Cui BT, Wang M and Ji GZ joined the clinical work; Zhang FM designed and organized the study and edited the paper.
Supported by Partially supported by the grant “Intestine Initiative”
Correspondence to: Fa-Ming Zhang, MD, PhD, Department of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jiayuan, Nanjing 210011, Jiangsu Province, China. fzhang@njmu.edu.cn
Telephone: +86-25-58509883 Fax: + 86-25-58509931
Received: April 10, 2014
Revised: June 18, 2014
Accepted: July 16, 2014
Published online: November 21, 2014
Abstract

Eosinophilic gastroenteritis is a rare disease of unknown etiology. It is characterized by patchy or diffuse eosinophilic infiltration of the bowel wall to a variable depth and various gastrointestinal manifestations. We describe a case of severe eosinophilic gastroenteritis presenting as frequent bowel obstruction and diarrhea in a 35-year-old man. The patient was misdiagnosed and underwent surgery because of intestinal obstruction when he was first admitted to a local hospital. Then he was misdiagnosed as having Crohn’s disease in another university teaching hospital. Finally, the patient asked for further treatment from our hospital because of the on-going clinical trial for treating refractory Crohn’s disease by fecal microbiota transplantation. Physical examination revealed a slight distended abdomen with diffuse tenderness. Laboratory investigation showed the total number of normal leukocytes with neutrophilia as 90.5%, as well as eosinopenia, monocytopenia and lymphocytopenia. Barium radiography and sigmoidoscopy confirmed inflammatory stenosis of the sigmoid colon. We diagnosed the patient as having eosinophilic gastroenteritis by multi-examinations. The patient was treated by fecal microbiota transplantation combined with oral prednisone, and was free from gastrointestinal symptoms at the time when we reported his disease. This case highlights the importance of awareness of manifestations of a rare disease like eosinophilic gastroenteritis.

Keywords: Eosinophilic gastroenteritis, Bowel obstruction, Diarrhea, Fecal microbiota transplantation, Prednisone

Core tip: We report a case of severe eosinophilic gastroenteritis presenting as frequent bowel obstruction and diarrhea in a 35-year-old man. The patient was misdiagnosed and underwent surgery because of intestinal obstruction when he was first admitted to a local hospital. Then he was misdiagnosed as having Crohn’s disease in another hospital. Here we present our experience of diagnosis and treatment with fecal microbiota transplantation and oral prednisone for this case. This case is characterized by the unusual features of eosinophilic gastroenteritis and effects of novel therapy.