Subserous Eosinophilic Gastroenteritis: A Rare Cause of Ascites

Eosinophilic gastroenteritis is an inflammatory gastrointestinal disease characterized by eosinophilic infiltration of the digestive tract. The subserous type is the rarest form and diagnosis is challenging because the symptoms are heterogeneous and endoscopy may be non-diagnostic. The authors describe the clinical case of a 41-year-old female patient who was diagnosed with subserous eosinophilic gastroenteritis. This case highlights the importance of clinical suspicion of eosinophilic gastroenteritis in patients in the third to fifth decades of life with gastrointestinal symptoms, ascites and eosinophilia. LEARNING POINTS: Subserous eosinophilic gastroenteritis is an uncommon inflammatory gastrointestinal disease with a challenging diagnosis because the symptoms are heterogeneous and endoscopy may be non-diagnostic. The diagnosis should be suspected in the presence of gastrointestinal symptoms, and peripheral eosinophilia is confirmed by the presence of eosinophilic infiltration of the gastrointestinal tract or ascites with a predominance of eosinophils, after the exclusion of other causes of eosinophilia. Automated cell counting analysis of the ascitic fluid can wrongly identify eosinophils as neutrophils, which can delay the diagnosis.