“Hidden in the Gut”, Eosinophilic Colitis Unveiled through Histopathology, Unexplained Abdominal Pain and Diarrhea with Marked Eosinophilia: A Case Report

Jalil Z, Kumar N, Sandeelo N, Aamir A, Haroon H, Hassan S and Kumari V

Published on: 2025-11-24

Abstract

Eosinophilic colitis (EC) is a rare subtype of eosinophilic gastrointestinal disorders characterised by eosinophilic infiltration of the colonic wall in patients with gastrointestinal symptoms. We present the case of a 42-year-old woman with a two-year history of intermittent abdominal pain and recent onset of diarrhea. Laboratory investigations revealed marked peripheral eosinophilia and elevated serum IgE levels. Endoscopic evaluation was grossly unremarkable; however, histopathological examination of colonic biopsies confirmed the diagnosis of EC, with over 100 eosinophils per high-power field (HPF). Secondary causes of eosinophilia were excluded through comprehensive imaging and laboratory workup. The patient responded well to corticosteroid therapy, with symptomatic improvement and normalization of eosinophil counts. This case highlights the diagnostic challenges of EC, particularly in low-resource settings, and emphasizes the need for biopsy in patients with unexplained eosinophilia and normal endoscopic findings.