Successful treatment of eosinophilic colitis by montelukast sodium plus budesonide in a patient with Waldenstrom macroglobulinemia.

Ingle SB et al.1 reported concerning a patient with eosinophilic gastroenteritis (EGE) in a recent issue of your journal, whose chronic diarrhea was successfully treated with oral steroids. This patient stimulated our interest because there is a lack of data in the literature regarding the therapeutic role of steroids in the treatment of EGE. The present case report is also noteworthy because it illustrates the importance of early endoscopy with biopsy in patients presenting with malabsorption and peripheral eosinophilia, in whom treatment with low dose steroids could prevent grave complications and morbidity of this disease. We would like to present a case with Waldenstrom macroglobulinemia (WM), who was suffering from diarrhea for over 10 years, in whom an eosinophilic colitis (ECO) diagnosis was achieved as the cause of diarrhea after a detailed clinical and laboratory investigation. A 62-year old female was admitted to our tertiary referral center hospital having had intermittent diarrhea and dyspepsia for over 10 years. The patient was previously diagnosed as WM and was treated accordingly. Although gastroenterologic complaints of the patient were not completely resolved with WM treatment, we decided to perform a detailed clinical and laboratory examination for a possible underlying gastrointestinal pathology. Her biochemical tests were normal, except for hypocalcemia and hypoalbuminemia. The patient's complete blood count revealed an elevated white blood cell (WBC) count of 14500/mm3 with marked eosinophilia of 27% and an absolute eosinophil count of 3915/mm3. Peripheral blood smear revealed marked mature eosinophilia with no evidence of any parasites. Double balloon enteroscopy using an oral route revealed a diagnosis of non-specific jejunitis. Colonoscopy revealed a pancolitis with moderate mucosal edema and inflammation. Histopathological examination of the colonic biopsy specimen showed dense eosinophilic infiltration of the colonic mucosa. Moreover, raised IgE levels with serum immunoelectrophoresis also supported the diagnosis of ECO. Treatment with oral montelukast sodium (a leukotriene receptor antagonist) and budesonide was initiated immediately and the patient reported complete