Clin Endosc.  2015 Mar;48(2):174-177. 10.5946/ce.2015.48.2.174.

Eosinophilic Gastroenteritis Due to Rhus Ingestion Presenting with Gastrointestinal Hemorrhage

• Choi W
• Park SY
• Choi C
• Cho K
• Park CH
• Kim HS
• Choi SK
• Rew JS

• KMID: 1801211
• DOI: http://doi.org/10.5946/ce.2015.48.2.174

Abstract

Rhus-related illnesses in Korea are mostly caused by ingestion of parts of the Rhus tree. Contact dermatitis occurrence after ingestion of Rhus-related food is very common in Korea. However, Rhus-related gastrointestinal disease is very rare. Herein, we present a case of eosinophilic gastroenteritis caused by Rhus ingestion. A 75-year-old woman was admitted with hematemesis and hematochezia after Rhus extract ingestion. Routine laboratory tests revealed leukocytosis without eosinophilia. Endoscopy showed friable and granular mucosal changes with touch bleeding in the second portion of the duodenum. Abdominal computed tomography revealed edematous wall thickening of the duodenum and proximal jejunal loops. Patch testing with Rhus extracts showed a strong positive reaction, suggesting Rhus as the allergen. Her symptoms improved after avoidance of the allergen.

Keyword

Eosinophilic enteropathy; Rhus; Gastrointestinal hemorrhage

MeSH Terms

Aged
Dermatitis, Contact
Duodenum
Eating*
Endoscopy
Eosinophilia
Eosinophils*
Female
Gastroenteritis*
Gastrointestinal Diseases
Gastrointestinal Hemorrhage*
Hematemesis
Hemorrhage
Humans
Korea
Leukocytosis
Patch Tests
Rhus*
Trees

Figure

• 

  Fig. 1 (A-D) Abdominal computed tomography image showing edematous wall thickening in the duodenum and proximal jejunal loops.

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  Fig. 2 (A-D) Endoscopy image showing friable and granular mucosal changes with touch bleeding in the second portion of the duodenum. However, there was no involvement of the stomach and duodenal bulb.

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  Fig. 3 Pathologic findings showing edematous gastric mucosa and diffusely infiltrated inflammatory cells containing over 100 eosinophils per high power field, consistent with eosinophilic gastroenteritis (A: H&E stain, ×100; B: H&E stain, ×400).

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  Fig. 4 (A-F) Patch test. A Rhus extract-containing patch was applied for 48 hours, and then removed. Seventy-two hours after application, the skin showed erythematous infiltration with ulceration, which is a strongly positive reaction.

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  Fig. 5 (A-D) Follow-up endoscopy image showing continued improvement of the mucosal edema and nodularity in the duodenum.

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