난치성 철분결핍빈혈로 발현된 호산구성 위염 1례

난치성 철분결핍빈혈로 발현된 호산구성 위염 1례

Eosinophilic gastritis presenting with intractable iron deficiency anemia in a young boy

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Release Date : 2017. 10. 26(목)
Seongyeon Kang1, Geunmoo Lee1 , Jeana Hong1
Kangwon National University Hospital Department of Pediatrics1
Kangwon Medical University School of Medicine Department of Pediatrics2
강성연1, 이근무1 , 홍지나1
강원대학교병원 소아청소년과1
강원대학교 의학전문대학원 소아과학교실2

Abstract

Introduction: Eosinophilic gastritis (EG) is a very rare disease classified as eosinophilic gastrointestinal disorder (EGID). Unlikely eosinophilic esophagitis, EG in children has not been well documented as a separate disease entity and has mostly been reported as eosinophilic gastroenteritis. Therefore, the clinical features of pediatric EG are not well known. We describe a boy who had been treated for refractory iron deficiency anemia without any evidence of gastrointestinal (GI) blood loss and was finally confirmed to have EG based on endoscopic evaluation. Case: An 8-year-old boy presented to our clinic with a 6-month history of intermittent vomiting. Other than vomiting episodes once or twice a month, he had no other GI symptoms. He had no significant past medical or family history and his physical examination was unremarkable. Laboratory findings were compatible with iron deficiency anemia with negative stool occult blood. After 6 weeks of iron replacement and an H2-receptor antagonist, his anemia persisted, but the vomiting ceased. An additional 3 months of double-dose iron resulted in slight improvement in iron levels. He was brought to the clinic after being lost to follow-up for 2 years, with a recurrence of vomiting once or twice a month, worsening anemia, and a positive stool occult blood test. Esophagogastroduodenoscopy revealed polypoid and nodular mucosal lesions throughout the gastric body, relatively sparing the antrum. The esophageal and duodenal mucosa were relatively unremarkable. Colonoscopy showed no abnormal findings. Histological examination revealed eosinophilic infiltration of the lamina propria with perivascular infiltration confined to the stomach, compatible with the minimum threshold count needed to satisfy the diagnostic criterion for EGID. With the impression of EG without food sensitization, he was treated with prednisone and lansoprazole. At follow-up after completing the course of prednisone, his hemoglobin was stable and his vomiting had completely resolved. Conclusion: A higher index of suspicion for EG is required when a patient has intractable anemia despite the absence of peripheral eosinophilia, atopic history, or definitive GI symptoms. Therefore, we recommend early endoscopic evaluation in patients with unexplained anemia or uncomplicated reflux symptoms.

Keywords: Anemia, eosinophil, gastritis