Eosinophilic Enteritis Presenting as Massive Ascites after Influenza A Virus Infection in a Young Female

젊은 여성에서 인플루엔자 A 바이러스 감염 후 발생한 복수를 동반한 호산구성 소장염 1예

  • Kim, Myung Jin (Division of Gastroenterology, Department of Internal Medicine, CHA University School of Medicine, CHA Gumi Medical Center) ;
  • Oh, Myung Jin (Division of Gastroenterology, Department of Internal Medicine, CHA University School of Medicine, CHA Gumi Medical Center)
  • 김명진 (차의과학대학교 부속 구미차병원 소화기내과) ;
  • 오명진 (차의과학대학교 부속 구미차병원 소화기내과)
  • Received : 2019.04.03
  • Accepted : 2019.05.20
  • Published : 2019.09.25


Eosinophilic gastrointestinal disorder (EGID) is an uncommon disease that is accompanied by intestinal eosinophil infiltration without a secondary cause of eosinophilia. Eosinophilic enteritis is a secondary portion of EGID that can present a range of gastrointestinal symptoms according to the affected depth of the intestinal layer. The subserosal type of eosinophilic enteritis presenting as ascites is relatively rarer than the mucosal type. In general, eosinophilic enteritis occurs in patients with food allergies, but its mechanism is unclear. The authors experienced a 29-year-old female patient with a large amount of ascites with diarrhea and abdominal pain. The patient was diagnosed with an influenza A infection one week earlier. Peripheral eosinophilia (absolute eosinophil count: 6,351 cells/㎣) and eosinophilic ascites (97% of white blood cells in the ascites are eosinophil) were present. Abdominal CT revealed a large amount of ascites and edematous changes in the ileum and ascending colon wall. A diagnosis of eosinophilic enteritis was confirmed as eosinophilic ascites by paracentesis, with eosinophil infiltration of the bowel wall by an endoscopic biopsy. The patient's symptoms improved rapidly after using steroids. To the best of the author's knowledge, this is the first report of eosinophilic enteritis with massive ascites after an influenza A virus infection in a Korean adult.


  1. Rothenberg ME. Eosinophilic gastrointestinal disorders (EGID). J Allergy Clin Immunol 2004;113:11-28.
  2. Pineton de Chambrun G, Dufour G, Tassy B, et al. Diagnosis, natural history and treatment of eosinophilic enteritis: a review. Curr Gastroenterol Rep 2018;20:37.
  3. Lee J, Dierkhising R, Wu TT, Alexander J, Weiler C. Eosinophilic gastrointestinal disorders (EGID) with peripheral eosinophilia: a retrospective review at Mayo Clinic. Dig Dis Sci 2011;56:3254-3261.
  4. Mansoor E, Saleh MA, Cooper GS. Prevalence of eosinophilic gastroenteritis and colitis in a population-based study, from 2012 to 2017. Clin Gastroenterol Hepatol 2017;15:1733-1741.
  5. Klein NC, Hargrove RL, Sleisenger MH, Jeffries GH. Eosinophilic gastroenteritis. Medicine (Baltimore) 1970;49:299-319.
  6. Kwon JY, Huh JS, Je BK, Hong KD, Lee JH. Eosinophilic gastrointestinal disorder presenting as intractable vomiting and ascites in a young girl. Pediatr Gastroenterol Hepatol Nutr 2017;20:198-203.
  7. Sheikh RA, Prindiville TP, Pecha RE, Ruebner BH. Unusual presentations of eosinophilic gastroenteritis: case series and review of literature. World J Gastroenterol 2009;15:2156-2161.
  8. Minodier L, Charrel RN, Ceccaldi PE, et al. Prevalence of gastrointestinal symptoms in patients with influenza, clinical significance, and pathophysiology of human influenza viruses in faecal samples: what do we know? Virol J 2015;12:215.
  9. Zhang M, Li Y. Eosinophilic gastroenteritis: a state-of-the-art review. J Gastroenterol Hepatol 2017;32:64-72.
  10. Takeyama J, Abukawa D, Miura K. Eosinophilic gastroenteritis with cytomegalovirus infection in an immunocompetent child. World J Gastroenterol 2007;13:4653-4654.
  11. Koga M, Fujiwara M, Hotta N, Matsubara T, Suzuki E, Furukawa S. Eosinophilic gastroenteritis associated with Epstein-Barr virus infection in a young boy. J Pediatr Gastroenterol Nutr 2001;33:610-612.
  12. Terai M, Honda T, Yamamoto S, et al. Early induction of interleukin-5 and peripheral eosinophilia in acute pneumonia in Japanese children infected by pandemic 2009 influenza A in the Tokyo area. Microbiol Immunol 2011;55:341-346.
  13. Sladkova T, Kostolansky F. The role of cytokines in the immune response to influenza A virus infection. Acta Virol 2006;50:151-162.
  14. Zhu FL, Ling AS, Wei Q, Ma J, Lu G. Tumor markers in serum and ascites in the diagnosis of benign and malignant ascites. Asian Pac J Cancer Prev 2015;16:719-722.
  15. Hallal H, Mas Mercader P, Alberca de las Parras F, et al. Eosinophilic gastroenteritis and CA-125 elevation. Gastroenterol Hepatol 2004;27:292-293.