Kyle A. Burton, MD; Jack Koueik, MD; Mark D. Oliver, DO; Daniel L. Rosenberg, MD; Melissa MacDonald, MD
WMJ. 2026;125(4):521-525. Published November 1, 2026.
ABSTRACT
Introduction: Eosinophilic gastrointestinal disease (EGID) is a rare disorder characterized by gastrointestinal symptoms and eosinophilic infiltration of the gastrointestinal tract in the absence of secondary causes of eosinophilia.
Case Presentation: A 76-year-old man presented with abdominal pain, early satiety, and ascites. Imaging and laparoscopy were concerning for peritoneal carcinomatosis. Laboratory evaluation revealed peripheral eosinophilia. Extensive infectious, autoimmune, and neoplastic evaluations were negative. Biopsies and cytology revealed no evidence of malignancy but demonstrated eosinophilic tissue infiltration supporting a diagnosis of EGID. Corticosteroid treatment led to rapid resolution of eosinophilia. The patient was diagnosed with serosal EGID and subsequently transitioned to mepolizumab, with sustained disease control.
Discussion: Hypereosinophilia often requires extensive evaluation. This case highlights the diagnostic complexity of EGID, particularly when it mimics advanced malignancy.
Conclusions: EGID should be considered in patients with unexplained eosinophilia and radiographic findings suggestive of malignancy, particularly within the abdomen or gastrointestinal tract. Early recognition may prevent unnecessary interventions and allow timely initiation of effective therapy.