Intest Res.  2016 Jul;14(3):280-284. 10.5217/ir.2016.14.3.280.

Chronic intractable diarrhea caused by gastrointestinal mastocytosis

• Seo H
• Park SH
• Byeon JS
• Woo CG
• Hong SM
• Chang K
• So H
• Kwak M
• Kim WS
• Lee JM
• Yang DH
• Kim KJ
• Ye BD
• Myung SJ
• Yang SK

• KMID: 2354971
• DOI: http://doi.org/10.5217/ir.2016.14.3.280

Abstract

As mast cells have been highlighted in the pathogenesis of diarrhea-predominant irritable bowel syndrome, a new term "mastocytic enterocolitis" was suggested by Jakate and colleagues to describe an increase in mucosal mast cells in patients with chronic intractable diarrhea and favorable response to treatment with antihistamines. Although it is not an established disease entity, two cases have been reported in the English medical literature. Here, for the first time in Asia, we report another case of chronic intractable diarrhea caused by gastrointestinal mastocytosis. The patient was a 70-year-old male with chronic intractable diarrhea for 3 months; the cause of the diarrhea remained obscure even after exhaustive evaluation. However, biopsy specimens from the jejunum were found to have increased mast cell infiltration, and the patient was successfully treated with antihistamines.

Keyword

Mastocytic enterocolitis; Mast cells; Diarrhea

MeSH Terms

Aged
Asia
Biopsy
Diarrhea*
Histamine Antagonists
Humans
Irritable Bowel Syndrome
Jejunum
Male
Mast Cells
Mastocytosis*
Histamine Antagonists

Figure

• 

  Fig. 1 Endoscopic findings of the jejunum in the study patient. Mucosal changes indicative of metaplasia and mucosal nodularity were observed.

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  Fig. 2 Representative histological and CD117 (KIT) immunohistochemical images of the study patient. (A) Duodenal biopsy revealed blunting of the intestinal villi, detachment of surface epithelial cells, depletion of goblet cells, and moderate lymphoplasmacytic and mild eosinophilic infiltration into the lamina propria and crypts (H&E, ×400). (B) Increased mast cell infiltrations into the lamina propria; >50 mast cell infiltrations per high power field were observed (toluidine blue staining and CD117 [KIT] immunohistochemical staining, ×400).

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