Eosinophilic colitis

Eosinophilic colitis, abbreviated EC, is an inflammatory process involving the colon (colitis) characterized by abundant eosinophils.

Eosinophilic colitis
Diagnosis in short
Eosinophilic colitis. H&E stain.
LM	abundant eosinophils - no agreed upon number - "most use 20/HPF", there is variation along the large bowel - normal in rectum <10/HPF, normal in cecum <30/HPF
Site	colon
Blood work	+/-eosinophilia
Treatment	dependent on underlying cause

Eosinophilic proctitis redirects to this article, as the histology is quite similar.

General

• Rare.
• May be a component of eosinophilic gastroenteritis.

Clinical features:

• Abdominal pain
• Diarrhea +/-blood.
• +/-Weight loss.

Gross

Features - endoscopic:

• Edema.
• Granular appearance.

Microscopic

Features:

• Abundant eosinophils - no agreed upon number.
  • "Most use 20/HPF" - a definition that suffers from HPFitis.
    • There is variation along the large bowel - normal in rectum <10/HPF, normal in cecum <30/HPF.
• +/-Eosinophilic crytitis.

DDx:

• Inflammatory bowel disease:
  • Crohn's disease.
  • Ulcerative colitis.
• Infection:
  • Pinworm.
  • Strongyloidiasis.
• Autoimmune disease:
  • Scleroderma.
  • Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome).
  • Celiac disease.
• Drug reactions.

Images

www:

• EC (nih.gov).

• 

  EC - intermed. mag. (WC)

• 

  EC - high mag. (WC)

• 

  EC - high mag. (WC)

• 

  EC - very high mag. (WC)

• 

  EC - very high mag. (WC)

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DESCENDING COLON, BIOPSY:
- COLONIC MUCOSA WITH MILD EOSINOPHILIA, SEE COMMENT.
- NEGATIVE FOR DYSPLASIA.

COMMENT:
Focally, there are up to 40 eosinophils / 0.2376 mm*mm (approx. field area at 400X). This
is a non-specific finding. No eosinophilic crypt abscesses are seen. No (neutrophilic)
cryptitis is present. Clinical correlation is suggested.

DESCENDING COLON, BIOPSY:
- COLONIC MUCOSA WITH MILD EOSINOPHILIA, SEE COMMENT.
- NEGATIVE FOR ACTIVE COLITIS.
- NEGATIVE FOR DYSPLASIA.

COMMENT:
There are up to 40 eosinophils / 0.2376 mm*mm (field area at 400X). This is a 
non-specific finding.  The differential diagnosis includes inflammatory bowel 
disease, infection (especially helminths), a drug reaction, and autoimmune 
disorders (e.g. Churg-Strauss syndrome, celiac disease, scleroderma). Clinical 
correlation is required.

See also

• Colon.
• Eosinophilic esophagitis.
• Eosinophilic gastritis.
• Eosinophil.