Diagnostic Snapshot: A Patient With Gastrointestinal Symptoms and Eosinophilia

© 2019 Harborside Press® J Adv Pract Oncol 2019;10(2):180–183 HISTORY Mr. C, a 63-year-old Cape Verdean male, was referred to the hematology/oncology office for evaluation of eosinophilia in May 2017. The eosinophilia was first documented in December 2003 by his primary care provider. In March 2005, Mr. C underwent colonoscopy for mild rectal bleeding and was incidentally found to have eosinophilic colitis. Stool ova and parasite testing was negative. Because he was asymptomatic at the time, no treatment was initiated. One year later (2006), Mr. C developed dyspepsia in the presence of continued eosinophilia. An upper endoscopy with biopsy was performed, revealing Helicobacter pylori–positive chronic active gastritis. He was treated with a 14-day course of triple therapy. Follow-up H. pylori antigen stool test was negative. In April 2017, Mr. C developed recurrent abdominal pain for which an endoscopy and colonoscopy were performed. Biopsies of the cecum, splenic flexure, and sigmoid colon were significant for eosinophilic infiltrates. A complete blood count demonstrated eosinophilia with normal hemoglobin, white blood cell, and platelet counts. Stool testing using an extended gastrointestinal panel was unremarkable. It was at this time that Mr. C was referred to hematology/oncology. Past medical history was significant for diabetes, hypertension, and hyperlipidemia. Mr. C did not have a history of asthma or food/drug allergies. His medications included amlodipine at 25 mg, aspirin at 325 mg, glipizide at 5 mg, metformin at 1,000 mg, and pravastatin at 80 mg. A review of systems revealed that Mr. C was negative for any fevers, night sweats, weight loss, rash/pruritus, dyspnea, or diarrhea. A physical exam showed normal vital signs, no palpable adenopathy, normal cardiopulmonary exam, no hepatosplenomegaly, no palpable masses, and no skin rashes or nodules. A computed tomography scan of the chest, abdomen, and pelvis was unremarkable. No adenopathy, masses, or hepatosplenomegaly were noted. Mr. C’s labs are shown in Tables 1 and 2. Th is ar tic le is dis tri bu te d u nd er th e t er m s o f t he Cr ea tiv e C om m on s A ttr ibu tio n N on -C om m er cia l L ice ns e, wh ich pe rm its