Presentation
Lower abdominal pain, multiple evaluations in the emergency department.
Patient Data
Ascending through transverse colitis. Mild inflammation of the jejunum. Mild ascites. Minor bladder wall thickening. Fibroid uterus.
Resolution of ascending colitis with new descending colitis. Persistent inflammation of the jejunum. Increased ascites. Worsening cystitis.
Resolved colitis. Increased ascites. Persistent mild jejunal inflammation. New severe inflammation of much of the ileum with target appearance.
Case Discussion
Very challenging clinical and radiological case with changing imaging features over a short period of time. It is remarkable and unusual to see a shifting pattern of colitis and enteritis over a 2-week timeframe, prompting consideration for uncommon diagnoses.
This patient underwent extensive workup and was found to have EDG/colonoscopy biopsies with focally increased eosinophils, eosinophilia on bone marrow biopsy, and elevated eosinophils in the ascites. The patient rapidly improved after starting steroids, helping to confirm the diagnosis.
The differential diagnosis for such a pattern of small bowel inflammation as seen on the last series also includes vasculitis (such as lupus), Crohn disease, and ACE-inhibitor-related angioedema.
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