Eosinophilic Ascites: Uncommon Presentation of Eosinophilic Gastroenteritis in a Young Adult Male.

g/dL), erythrocyte sedimentation rate (1 mm), and liver enzymes were within normal ranges. Abdominal ultrasound confirmed moderate ascites, and computed tomography enterography ( fig. 1 ) showed diffuse thickening of the gastric and proximal small bowel wall (arrowheads) and peritoneal fluid (arrow). Ascitic fluid analysis after an abdominal tap revealed a serum-ascites albumin gradient <1.1 g/dL and significant eosinophilia ( fig. 2 , inset). Esophagogastroduodenoscopy did not reveal significant endoscopic findings; however, transendoscopic gastric biopsies showed marked eosinophilic infiltration (>25 eosinophils/high-powerfield magnification) ( fig. 2 ). Esophageal biopsies did not show criteria for eosinophilic esophagitis. Imaging and pathology findings were, therefore, consistent with eosinophilic gastroenteritis (EGE). Differential diagnosis including food allergy, parasitic infections, inflammatory bowel diseases, malignancy, and other eosinophilic disorders (such as Churg-Strauss syndrome and hypereosinophilic syndrome) [1] were taken into account. Extensive investigation (including allergen-specific serum IgE, skin-prick tests, stool examinations, colonoscopy with ileoscopy and biopsies, abdominal and thoracic CT-scan, peripheral blood smear, serum protein electrophoresis, electrocardiography, echocardiography and troponin levels, as well as consultations with hematology, immuno-allergology and ear, nose and throat doctors) ruled out these conditions. Treatment with a course of oral prednisolone (40 mg/day for 7 days, then tapered by 5 mg/week) resulted in peripheral blood eosinophil count normalization within 24 h and symptom resolution after 4 days. Since the patient was an adult, no food allergy was Keywords