Vitamin D deficiency causing eosinophilic esophagogastroenteritis and ascites: A rare association

• Main Authors: Qua, Choon-Seng, Peh, Kaik-Boo, Saravannan, Kannan, Goh, Khean-Lee
• Format: Article
• Published: BMJ Publishing Group 2021
• Subjects: R Medicine (General); RC Internal medicine
• Online Access: http://eprints.um.edu.my/35168/
• Institution: Universiti Malaya

A 54-year-old Chinese man presented with ascites for 2 weeks. He had a preceding 2-year history of intermittent dysphagia, lethargy and general malaise. Blood investigations revealed leucocytosis with eosinophilia of 26.5%, whereas paracentesis showed turbid fluid with high protein content (45g/L) and a high white blood cell count of 5580/mu L, predominantly eosinophils (90%). An incidental assay of vitamin D showed a very low level of 13.5ng/mL. No other cause of ascites was found. Gastroscopy was normal except for duodenitis. However, biopsies from lower oesophagus confirmed the presence of eosinophilic infiltration. Following vitamin D replacement, the patient experienced marked improvement in symptoms of dysphagia within 2 weeks and no recurrence of ascites after 3 months. The reason for the patient's vitamin D deficiency remains unclear. The marked improvement in the patient's health indicates a causative role of vitamin D deficiency in causing eosinophilic esophagogastroenteritis and associated eosinophilic ascites.