Eosinophilic gastroenteritis (EGE) is a rare condition characterized
by eosinophilic infiltration of the gastrointestinal tract. It is classified
into mucosal, muscular, and sub-serosal types, depending on the
clinical picture and the depth of eosinophilic infiltration within the
gastrointestinal wall. Sub-serosal type, the most uncommon variant,
which is complicated by ascites and peripheral hypereosinophilia,
usually results in the most severe clinical form of eosinophilic
gastroenteritis and requires early therapy. The clinical features are
non-specific with history of atopic predisposition and allergy.
Endoscopic biopsy is frequently non-diagnostic due to an uninvolved
gastrointestinal mucosa rendering its diagnosis a challenge.
The backbone of diagnosis is peripheral hypereosinophilia and
eosinophil-rich ascitic fluid on diagnostic paracentesis. Oral steroid
therapy is usually the first line of treatment with dramatic response.
Due to a propensity for relapse, steroid-sparing therapy should be
considered for relapses of EGE. We report a case of subserosal EGE
with diagnostic clinical features and treatment response and review
the current strategy in the management of eosinophilic ascites.