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Park, Kim, Kim, Lee, Kim, Yoo, Kim, Jung, Kim, Hyun, and Choi: Eosinophilic cholecystitis: A rare manifestation of hypereosinophilic syndrome
Case Report

Allergy, Asthma & Respiratory Disease 2014; 2(3): 222-226.

Published online: 31 July 2014

DOI: https://doi.org/10.4168/aard.2014.2.3.222

Eosinophilic cholecystitis: A rare manifestation of hypereosinophilic syndrome

Jae-Hyun Park1, Byoung-Hoon Kim1, Mi-Kang Kim1, Jae-Eun Lee1, Kwang-Taek Kim1, Jun-Jae Yoo1, Hee-Jun Kim1, Sung-Won Jung1, Cheol-Hong Kim1, 2, In-Gyu Hyun1, 2, Jeong-Hee Choi1, 2

1Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.

2Lung Research Institute, Hallym University College of Medicine, Chuncheon, Korea.

Correspondence to: Jeong-Hee Choi. Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, 7 Keunjaebong-gil, Hwaseong 445-907, Korea. Tel: +82-31-8086-2928, Fax: +82-31-8086-2482, mdqueen@hallym.or.kr

Received 14 October 2013       Revised 25 November 2013       Accepted 26 November 2013

© 2014 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Eosinophilic cholecystitis (EC) is a rare form of acute cholecystitis, of which diagnosis is based on classical symptoms of cholecystitis with a presence of >90% eosinophilic infiltration within the gall bladder. EC rarely manifests in idiopathic hypereosinophilic syndrome (IHES). Here, we report two cases of EC with IHES. One is a 57-year-old male who presented with acute right upper quadrant (RUQ) pain, jaundice and fever. The initial peripheral blood eosinophil count was 2,070/mm3, and further elevated to 12,590/mm3. Acute acalculous cholecystitis with cholangitis was confirmed by computed tomography (CT). He improved with endocopic nasobiliary drainage and antibiotic therapy. The other is a 64-year-old female who presented with acute RUQ pain. She also complained of dyspnea and tingling sensation of both hands and feet. The initial peripheral blood eosinophil count was 10,400/mm3. Abdominal CT revealed findings suggestive of acute acalculous cholecystitis. She improved with systemic glucocorticosteroid therapy. No other causes of hypereosinophilia were found in either patients. Thus, cholecystectomy may not be mandatory for the treatment of EC with IHES.

Keywords: Hypereosinophilic syndrome, Cholecystitis, Cholangitis

Figures and Tables

Fig. 1
(A) Abdominal computed tomography shows diffuse wall thickening and mild dilatation of gall bladder and common bile duct which is compatible with acute cholangitis and cholecystitis. (B) Endoscopic retrograde cholangiopancreatography shows normal passage of bile. There is not any filling defect in gall bladder and bile duct by stone or mass. (C) Esophagogastroduodenoscopic biopsy shows diffuse eosinophilic infiltration (>50/high power field) in the stomach (H&E, ×400).
aard-2-222-g001
Fig. 2
Clinical course of the patients. Total bilirubin (T. Bil) level (●) was gradually recoverd after endoscopic nasobiliary drainage (ENBD) insertion. Total peripheral eosinophil count (■) was also recovered from hospital day 8.
aard-2-222-g002
Fig. 3
Abdominal computed tomography (A) and magnetic resonance cholangiopancreatography (B) show mild distension and wall thickening of gall bladder (GB) and mild dilatation of common bile duct (CBD), which is compatible with acute cholecystitis. There are not GB or CBD stones.
aard-2-222-g003
Fig. 4
The progress of peripheral blood eosinophil count of the patient according to treatment. MPD, methylprednisolone.
aard-2-222-g004

Notes

This study was supported by a grant from the Basic Science Research Program through the National Research Foundation of Korea (NRF), as funded by the Ministry of Education, Science and Technology (2012R1A1A1012349).

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