JPGN Journal of Pediatric Gastroenterology and Nutrition Publish Ahead of Print DOI : 10.1097/MPG.0000000000000674
UNUSUAL ENDOSCOPIC FEATURES IN A CHILD WITH DRESS.
Celine Halb1, Massimiliano Paganelli1, Prevost Jantchou1, Isabelle Chevalier2, Dal-Soglio Dorothee3, Colette Deslandres1
1
Division of Pediatric Gastroenterology, Department of Pediatrics, CHU Ste-Justine, Montréal,
QC, Canada 2
Department of Pediatrics, CHU Ste-Justine, Montréal, QC, Canada
3
Departement of Pediatric Pathology, CHU Ste-Justine, Montréal, QC, Canada
Corresponding author: Dr. Celine Halb Division of Gastroenterology and Nutrition Hôpital Sainte-Justine 3175 Côte Sainte-Catherine Montréal, Québec, Canada H3T 1C5 Tel: 514-345-4931 Fax: 514-345-4999 Email: [email protected] No conflict of interest. No disclosure.
Copyright © ESPGHAN and NASPGHAN. All rights reserved.
A 5-year-old boy developed abdominal pain, photophobia and an urticarial rash several days after discontinuing amoxicillin for otitis media. His past medical history was unremarkable. After ten days of these symptoms, he was admitted to our hospital: C-reactive protein was increased to 259 mg/L (normal range 0-6 mg/L) and circulating eosinophils to 1000/μL (normal range 0-400/μL). On day 3, circulating eosinophils increased to 6900/μL and CRP to 410 mg/L. Abdominal ultrasound and CT-scan showed mild hepatosplenomegaly, mesenteric adenopathy and small bowel dilatation. Upper and lower gastrointestinal endoscopies showed unusual white eggshelllike lesions of the esophagus, stomach and duodenum. These lesions were subsequently identified as eosinophilic abscesses on histology. Intravenous corticosteroids were started at 2 mg/kg/day for DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms). After three days, clinical and laboratory improvement led us to switch to oral corticosteroids. Intravenous corticosteroids had to be resumed when clinical symptoms recurred and circulating eosinophilis increased to 5200/μL. We repeated the upper endoscopy, which showed a significant improvement with complete disappearance of the esophageal lesions. The patient tolerated slow prednisone tapering over three months and remained asymptomatic six months after prednisone discontinuation.
Copyright © ESPGHAN and NASPGHAN. All rights reserved.
A B Fig 1. A. A Image of eosinophilic e c abcess in tthe oesophaagus. B. Imaage of eosinoophilic abceess in the stomachh.
C d mucossa and subm mucosa with diffuse eosiinophilic infiltrate. HES Sx200 Fig 1.C. Biopsy of deep
Copyright © ESPGHAN and NASPGHAN. All rights reserved.
B A A Image off lesion-free oesophaguss. B. Image of the duoddenum with small persisstent Fig 2. A. lesions.
Copyright © ESPGHAN and NASPGHAN. All rights reserved.
UNUSUAL ENDOSCOPIC FEATURES IN A CHILD WITH DRESS.
Celine Halb1, Massimiliano Paganelli1, Prevost Jantchou1, Isabelle Chevalier2, Dal-Soglio Dorothee3, Colette Deslandres1
1
Division of Pediatric Gastroenterology, Department of Pediatrics, CHU Ste-Justine, Montréal,
QC, Canada 2
Department of Pediatrics, CHU Ste-Justine, Montréal, QC, Canada
3
Departement of Pediatric Pathology, CHU Ste-Justine, Montréal, QC, Canada
Corresponding author: Dr. Celine Halb Division of Gastroenterology and Nutrition Hôpital Sainte-Justine 3175 Côte Sainte-Catherine Montréal, Québec, Canada H3T 1C5 Tel: 514-345-4931 Fax: 514-345-4999 Email: [email protected] No conflict of interest. No disclosure.
Copyright © ESPGHAN and NASPGHAN. All rights reserved.
A 5-year-old boy developed abdominal pain, photophobia and an urticarial rash several days after discontinuing amoxicillin for otitis media. His past medical history was unremarkable. After ten days of these symptoms, he was admitted to our hospital: C-reactive protein was increased to 259 mg/L (normal range 0-6 mg/L) and circulating eosinophils to 1000/μL (normal range 0-400/μL). On day 3, circulating eosinophils increased to 6900/μL and CRP to 410 mg/L. Abdominal ultrasound and CT-scan showed mild hepatosplenomegaly, mesenteric adenopathy and small bowel dilatation. Upper and lower gastrointestinal endoscopies showed unusual white eggshelllike lesions of the esophagus, stomach and duodenum. These lesions were subsequently identified as eosinophilic abscesses on histology. Intravenous corticosteroids were started at 2 mg/kg/day for DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms). After three days, clinical and laboratory improvement led us to switch to oral corticosteroids. Intravenous corticosteroids had to be resumed when clinical symptoms recurred and circulating eosinophilis increased to 5200/μL. We repeated the upper endoscopy, which showed a significant improvement with complete disappearance of the esophageal lesions. The patient tolerated slow prednisone tapering over three months and remained asymptomatic six months after prednisone discontinuation.
Copyright © ESPGHAN and NASPGHAN. All rights reserved.
A B Fig 1. A. A Image of eosinophilic e c abcess in tthe oesophaagus. B. Imaage of eosinoophilic abceess in the stomachh.
C d mucossa and subm mucosa with diffuse eosiinophilic infiltrate. HES Sx200 Fig 1.C. Biopsy of deep
Copyright © ESPGHAN and NASPGHAN. All rights reserved.
B A A Image off lesion-free oesophaguss. B. Image of the duoddenum with small persisstent Fig 2. A. lesions.
Copyright © ESPGHAN and NASPGHAN. All rights reserved.
