PMC3356866_01
This computer tomography image of the abdomen and pelvis with oral and intravenous contrast shows multiple areas of small bowel wall thickening (arrowheads). Also notice the perihepatic accumulation of ascitic fluid (arrow).
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Abdominal and pelvis computer tomography (CT) showed moderate ascites with thickening of the gastric antrum and proximal small bowel (Figure 1).
This high-power oil immersion view of the peripheral blood shows two eosinophils. In addition, a lymphocyte is present as well as abundant background of red blood cells (Wright-Giemsa stain; magnification 1000x).
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Repeated blood counts and serum biochemical tests demonstrated an increase in white cell count of 17.100/mL with 71% eosinophils (absolute eosinophil count of 12.141/mul with normal upper limit <450) (Figure 2).
This high-power oil immersion view of ascitic fluid shows two degenerating eosinophils containing eosinophilic granules and bilobed nuclei (H&E stain; magnification 1000x).
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U/L (normal: 80-200), respectively. Ultrasound guided abdominal paracentesis showed WBC count of 6600/mL, 95% of which were eosinophils (Figure 3), LDH 284 mg/dL, albumin 3.2 g/dL (simultaneous serum albumin 4.1 g/dL).
Laparoscopic evaluation of the patient revealed skipped areas of serosal inflammation involving the small bowel and to a lesser degree the colon. This view of the biopsied part of jejunum reveals an area of hyperemia and dilated blood vessels indicating an inflammatory process (arrowheads).
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This revealed skipped areas of hyperemia and discoloration involving the small intestine and to a lesser degree the colon in addition to yellow-green ascites (Figure 4).
This high-power oil immersion view of the serosa shows sheets of eosinophils with abundant eosinophilic granules (H&E stain; magnification 1000x).
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Histopathological evaluation showed marked eosinophilic infiltration of the muscularis propria and serosa with concomitant mild acute inflammatory reaction (Figure 5).