A case of hypereosinophilic syndrome presenting with intractable gastric ulcers

• Published in: World journal of gastroenterology : WJG 2009-12, Vol.15 (48), p.6129-6133
• Main Authors: Park, Tae Young, Choi, Chang Hwan, Yang, Suh Yoon, Oh, In Soo, Song, In-Do, Lee, Hyun Woong, Kim, Hyung Joon, Do, Jae Hyuk, Chang, Sae Kyung, Cho, Ah Ra, Cha, Young Joo
• Format: Article
• Language: English
• Subjects: Aged; Case Report; Humans; Hypereosinophilic Syndrome - complications; Hypereosinophilic Syndrome - diagnosis; Male; Stomach Ulcer - etiology; 价格指数; 嗜酸性粒细胞; 嗜酸粒细胞; 扫描显示; 综合征; 胃溃疡; 质子泵抑制剂; 顽固性
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.15.6129

We report a rare case of hypereosinophilic syndrome （HES） presenting with intractable gastric ulcers. A 71-year-old man was admitted with epigastric pain. Initial endoscopic findings revealed multiple, active gastric ulcers in the gastric antrum. He underwent Helicobacterpylori （Hpylon） eradication therapy followed by proton pump inhibitor （PPI） therapy. However, follow- up endoscopy at 4, 6, 10 and 14 mo revealed persistent multiple gastric ulcers without significant improvement. The proportion of his eosinophil count increased to 43% （total count： 7903/mm3）. Abdominal-pelvic and chest computed tomography scans showed multiple small nodules in the liver and both lungs. The endoscopic biopsy specimen taken from the gastric antrum revealed prominent eosinophilic infiltration, and the liver biopsy specimen also showed eosinophilic infiltration in the portal tract and sinusoid. A bone marrow biopsy disclosed eosinophilic hyperplasia as well as increased cellularity of 70%. The patient was finally diagnosed with HES involving the stomach, liver, lung, and bone marrow. When gastric ulcers do not improve despite H pylon eradication and prolonged PPI therapy, infiltrative gastric disorders such as HES should be considered.