Bornacelly Mendoza Adriana Paola, Moscote Granadillo Mario Joaquín, Moreno Pallares Eiman Damián, Moscote Teran Carlos Mario
Programa de Especialización en Medicina Interna,. Universidad Libre. Barranquilla, -Colombia.
Programa de Especialización en Medicina Interna,. Universidad Libre. Barranquilla, -Colombia; Departamento de Gastroenterología, Clínica General del Norte. Barranquilla,-Colombia.
Rev Gastroenterol Peru. 2022 Oct-Dec;42(4):251-256.
Eosinophilic duodenitis has a prevalence of 5.1 to 8.2 per 100000 persons. The underlying molecular mechanisms are unknown, but hypersensitivity (seasonal and food allergies, asthma, eczema) response plays a major role in its pathogenesis, allergic predisposition can be found up-to 25-35% of cases. The diagnosis includes clinical manifestation, imaging findings and histological evidence of eosinophilic infiltration >20 eosinophils per high-power field. This is a clinical case report. a 25-years old man with vitiligo consult to emergency department referring dyspepsia symptoms, vomiting and abdominal pain of maximal intensity, in the medical exam upper abdominal pain was found, blood laboratories were unremarkable except a high net eosinophil-count >2000 cells/ul, abdominal ultrasound were normal, upper endoscopy revealed duodenitis with rigid and thickened folds, colonoscopy show hemorrhoids grade I. Coproscopy exam was negative for parasites, total IgE, IgA and IgG were in normal range, a positive IgG to Toxoplasma gondii was reported, autoimmunity panel was negative. In the following 4 days the abdominal pain and eosinophils count increase, a new abdomin-pelvic tomography was done showing thickened duodenum with a new endoscopy showing marked edema in duodenum with severe biliary reflux with biopsies describing an atrophic chronic duodenitis. Allergy tests -skin prick and patch tests- were done resulting positive to cereals (rye, soy, barley), Manihot esculenta, green banana, tomato, cow milk, orange and pineapple. A restrictive diet and protons pump inhibitor was indicated, ambulatory control at 45 days after show symptoms resolution with a normal blood eosinophils count. Here is reported a case of eosinophilic duodenitis related to food allergy in a young man with vitiligo debuting with an unusual clinical presentation of acute visceral pain and biliary reflux which resolved with elimination diet and pantoprazole without use of corticoids, with both, IgE and non-IgE mechanisms playing important roles explaining food sensitization.
嗜酸性粒细胞性十二指肠病的患病率为每10万人中有5.1至8.2例。其潜在的分子机制尚不清楚，但超敏反应（季节性和食物过敏、哮喘、湿疹）在其发病机制中起主要作用，高达25%至35%的病例存在过敏易感性。诊断包括临床表现、影像学检查结果以及嗜酸性粒细胞浸润的组织学证据（每高倍视野>20个嗜酸性粒细胞）。这是一篇临床病例报告。一名25岁患有白癜风的男性因消化不良症状、呕吐和剧烈腹痛到急诊科就诊，体格检查发现上腹部疼痛，血液检查除嗜酸性粒细胞计数高>2000个/微升外无异常，腹部超声正常，上消化道内镜检查显示十二指肠炎症伴皱襞僵硬增厚，结肠镜检查显示I级痔疮。粪便检查未发现寄生虫，总IgE、IgA和IgG在正常范围内，报告弓形虫IgG阳性，自身免疫指标阴性。在接下来的4天里，腹痛和嗜酸性粒细胞计数增加，进行了新的腹部盆腔断层扫描，显示十二指肠增厚，再次进行上消化道内镜检查显示十二指肠明显水肿伴严重胆汁反流，活检描述为萎缩性慢性十二指肠炎症。进行了过敏试验——皮肤点刺试验和斑贴试验——结果对谷物（黑麦、大豆、大麦）、木薯、青香蕉、番茄、牛奶、橙子和菠萝呈阳性。给予限制性饮食和质子泵抑制剂，45天后门诊复查显示症状缓解，血液嗜酸性粒细胞计数正常。本文报告了一例与食物过敏相关的嗜酸性粒细胞性十二指肠病病例，该病例发生在一名患有白癜风的年轻人身上，以急性内脏疼痛和胆汁反流这种不寻常的临床表现起病，通过排除饮食和泮托拉唑治疗得以缓解，未使用皮质类固醇药物，IgE和非IgE机制在解释食物致敏方面均发挥了重要作用。
