Videocapsule Endoscopy Identifies Small Bowel Lesions in Patients With Eosinophilic Enteritis

2-year-old boy presented with fatigue, anorexia, iron-deficiency anemia (hemoglobin level, 8.5 g/dL; mean corpuscular volume, 62.5 fL), hemoccult-positive stool, and peripheral eosinophilia (880 cells/mL). Upper endoscopy and colonoscopy were grossly and histologically unremarkable. Video capsule endoscopy (VCE) showed jejunal and proximal ileal salmon-colored patches (Figures A, B). Antegrade single balloon enteroscopy (Figure C) showed jejunal eosinophilia with 72 eosinophils per high-power field, densely packed in the lamina propria (Figure D). Clinical improvement was achieved with budesonide capsules.

Figure.

Eosinophilic gastrointestinal diseases are characterized by gastrointestinal symptoms and dense mucosal eosinophilia. Eosinophilic enteritis is rare, but can manifest with diarrhea, abdominal pain, or gastrointestinal bleeding. Here, we show a patient may present without any gastrointestinal symptoms and only evidence of protein and blood loss. Novel occult lesions, such as these salmon-colored patches, may extend beyond the reach of traditional endoscopy and thus combined approaches with visualization using VCE and mucosal capture by small-bowel enteroscopy provided an important diagnostic approach. VCE can identify small-bowel lesions in patients with suspicion for eosinophilic gastrointestinal diseases with clinical manifestations of protein-losing enteropathy or occult gastrointestinal blood loss. Salmon patches on VCE in the setting of peripheral eosinophilia should raise suspicion for eosinophilic enteritis.