Pneumococcal sepsis after autosplenectomy in a girl with systemic lupus erythematosus.

9 /l, corresponding to 2.3–17.6% of total white cell count) and this appeared to correlate with hypoalbuminaemia, implying a causal link between the two conditions. EE is an inflammatory disorder of unknown aetiology characterized by eosinophilic infiltration of the gastrointestinal tract. Any part of the gastrointestinal tract may be affected. Presenting symptoms may include abdominal pain, vomiting, diarrhoea, obstruction or malabsorption depending on the intestinal segment and the specific layer of the bowel wall involved. The clinical course of EE is usually chronic with exacerbations and remissions, as in our patient. The mainstay of treatment is corticosteroid therapy. Sodium cromoglycate, montelukast, suplatast tosilate, ketotifen and an elimination diet have also been tried with some success. Surgical intervention may be indicated for complications such as bowel obstruction or perforation. We considered the use of budesonide, which is locally effective in the gastrointestinal tract but not systemically absorbed. However, to date, this therapy has not been required. Several aetiological factors have been proposed, including food or drug allergy, parasitic infection and infestation. Furthermore, EE may also be part of the manifestation of hypereosinophilic syndrome, vasculitides or systemic mastoidosis [1, 2]. To date, only two cases of RA and EE have been reported [3, 4]. While the association between RA and peripheral blood eosinophilia is well recognized, the link between tissue eosinophilia and RA is less well established. Eosinophilic pneumonia, eosinophilic fasciitis, hypereosinophilic syndrome and cutaneous eosinophilic vasculitis have been described in patients with RA [5–8]. In our patient, there was no evidence of other systemic tissue eosinophilic infiltration outside the gastrointestinal tract. Quallich et al. [9] reported a case of severe reaction to sulphasalazine with peripheral eosinophilia, granulomatous enteritis and myelotoxicity in a patient with RA. Although our patient was taking sulphasalazine, her peripheral eosinophilia predated the treatment, and hence was unlikely to be the causative agent. In conclusion, we present a case of EE in a patient with RA. The reported association between RA and a variety of eosinophilic disorders suggests that our observation may be more than a coincidence, but represents a genuine link between these two conditions. The diverse symptomatology and the relapsing– remitting course of EE results in this condition being under-diagnosed, and should be actively sought in patients with RA with unexplained abdominal symptoms or oedema.Eosinophilic gastroenteritis associated with rheuma-toid arthritis. Its presentation as acute abdominal pain.] Rev Esp Enferm Dig 1997;89:143–4. 5. Chaudhuri K, Dubey S, …