Asia Pac Allergy.  2017 Oct;7(4):243-246. 10.5415/apallergy.2017.7.4.243.

Absence of esophageal eosinophilia in a toddler with severe eosinophilic esophagitis

• Loh W
• Wright KM
• Chiou FK

• KMID: 2410219
• DOI: http://doi.org/10.5415/apallergy.2017.7.4.243

Abstract

Eosinophilic esophagitis (EoE) is a clinicopathologic disease characterised by esophageal dysfunction and eosinophil-predominant inflammation. Diagnosing EoE in children is particularly challenging as they tend to present with nonspecific symptoms and their mucosal specimens may have less than the threshold number of eosinophils. Reluctance to subject children to multiple endoscopic procedures and anesthesia often results in treatment with a proton pump inhibitor (PPI) first to evaluate clinical response. This approach presents a problem as a diagnosis of EoE may be missed. Here we present a case of a child with severe EoE whose initial biopsy did not show esophageal eosinophilia but progressed on to advance dis ease despite clinical response to PPI therapy.

Keyword

Child; Eosinophilia; Eosinophilic esophagitis; Food allergy; Proton pump inhibitors

MeSH Terms

Anesthesia
Biopsy
Child
Diagnosis
Eosinophilia*
Eosinophilic Esophagitis*
Eosinophils*
Food Hypersensitivity
Humans
Inflammation
Proton Pump Inhibitors
Proton Pumps
Proton Pump Inhibitors
Proton Pumps

Figure

• 

  Fig. 1 Endoscopic image of the esophagus performed at 3 years of age, demonstrating concentric rings and nodularity in the mid and distal esophagus, and easy contact bleeding.

• 

  Fig. 2 (A) Biopsy taken from the mid esophagus at 18 months of age showing no pathological findings. (B) Biopsy taken from the mid esophagus at 3 years of age showing marked increase in eosinophils of up to 40 eosinophils/high-power field, including the formation of eosinophilic microabscesses. Scale bar represents 50 µm.

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