On November 2006, a 20-year-old man with oeosinophilic gastroenteritis was admitted to our ward due to pneumonia and severe protein-calorie malnutrition after partial gastrectomy, duodenectomy and cholecistectomy performed 15 days before to treat a bleeding pyloric ulcer.
The patient's familial anamnesis included the premature death of a 2-year-old sister for pneumonia and diarrhoea. At 2, 6 and 12 months of life he had episodes of pneumonia and diarrhoea and was diagnosed with T cell immunodeficiency and selective deficit of T cell helper lymphocytes.
He had reactions to many food allergens, and the attempt to introduce two selected foods that had been negative at the cutaneous prick tests resulted in vomiting, abdominal pain, diarrhoea and increased intestinal permeability. Therefore, he could not have a natural diet and was fed with an elementary diet since the first year of life.
At the age of 5 years, he was again admitted to hospital for abdominal pain. An upper gastrointestinal endoscopy showed gastrointestinal mucosa hyperaemia with erosions and ulcerations; the antropyloric region was obstructed and an oeosinophilic inflammatory infiltration was found in all biopsies. Repeated sweat tests were always negative as were the serum anti-transglutaminase and anti-endomisium antibodies; the α1-antitripsine and total immunoglobulin levels were in the normal range. He was diagnosed as having oeosinophilic gastroenteritis although steroid treatment (2 mg/kg/day for the first week and 0.5 mg/kg/day for the following 8 weeks) did not induce satisfying results14–17
; finally, enteral nutrition with an elemental diet through a nasogastric tube (NGT) was prescribed with satisfying effects on the disease symptoms.
At 6 years of age, he had Nissen anti-reflux surgery and a percutaneous endoscopic gastrostomy (PEG) positioning to continue the enteral nutrition with the elemental diet. During these years, growth rate was poor and recurring episodes of pneumonia and otitis were recorded.
Faringeal and sputum swabs were often positive for Staphylococcus aureus and Pseudomonas aeuruginosa. Laboratory data showed high IgE levels.
An upper endoscopy revealed a stenosis of the gastric antrum with oedematous and weak mucosa, but the probe could not go beyond the pylorus. The histology showed a chronic inflammatory infiltrate with a high percentage of oeosinophils. The iron load test was pathological, while gut permeability tests with lactulose and mannitol were within the normal range. The intestinal washing content showed a total immunoglobulin level at 12 mg/ml (nv<5) and an increased haemoglobin concentration.
At 10 years of age, he experienced gastric bleeding and an upper endoscopy showed a prepyloric ulcer with complete pylorus obstruction. He underwent pyloroplasty and the histology of the biopsy samples confirmed an increased number of oeosinophils.
At 20 years of age (19 days before admission to our hospital), he was urgently admitted for hypovolemic shock due to a bleeding pyloric ulcer; after several attempts of endoscopic haemostasis, he underwent gastroduodenal resection and cholecystectomy for dropsied cholecystis as already reported. The histological examination of the surgically resected bowel segment showed oedema, hyperaemia and lympho-plasmocitary infiltration of mucosa, hypertrophy and oedema of the muscolaris layer, and fibrosis with heavy oeosinophilic infiltration and numerous degranulated oeosinophils in all intestinal wall layers.
A few days later, he was again operated for choleperitoneum due to a gastric fistula on the PEG. Therefore, the PEG was removed and the perforations sutured but an entero-cutaneous fistula opened a few days later.