Eosinophilic Colitis in a Patient With Seronegative Rheumatoid Arthritis

Document Type

Conference Proceeding

Publication Date


Publication Title

American Journal of Gastroenterology


Introduction: Eosinophilic colitis (EoC) is the rarest eosinophilic gastrointestinal disease (EGID) with an overall prevalence of 2.1 per 100,000 subjects. EoC can be difficult to diagnose given the diverse symptomatology and high clinical suspicion required for recognition. In addition, association with autoimmune disease is seldom reported. Here, we discuss a unique case of EoC in a patient with seronegative rheumatoid arthritis (RA). Case Description/Methods: A 56-year-old woman with a 7-year history of seronegative RA presented with generalized abdominal pain, non-bloody diarrhea, and 30-pound weight loss. The patient denied a history of atopic diseases, sick contact, recent travel, medication changes, or family history of inflammatory bowel disease. She had been treated with methotrexate, leflunomide, and hydroxychloroquine with good tolerance. Workup included an elevated calprotectin level of 665 and normal stool studies. Colonoscopy revealed endoscopically normal colon. Random colon biopsies revealed increased eosinophils within the lamina propria (Figure 1A). The number of eosinophils ranged up to greater than 50 eosinophils per high-power field with focal eosinophilic cryptitis (Figure 1B). She did not have relief in symptoms with discontinuation of non-steroidal anti-inflammatory drugs, dairy products, and substitute sweeteners. The patient was ultimately diagnosed with EoC and given a trial of prednisone taper with improvement in symptoms. Discussion: The pathogenesis of RA induced EoC is hypothesized to involve the link between atopy and autoimmunity, referring to Th1/Th2 modulation. Chemoattractants, such as eotaxin, IL-5, and MCP-4, released by innate lymphoid cells and Th2 cells contribute to EoC pathogenesis. Treatment with systemic steroids can be associated with adverse effects and symptom recurrence, highlighting the importance of steroid-sparing medications. Immunomodulatory agents (azathioprine, 6-mercaptpurine) and anti-TNF agents (infliximab, adalimumab) have been tried in severe, steroid-refractory EoC with promising results. Targeted therapy in the form of biologics are still being studied in the treatment of EGID. Clinicians who encounter patients with underlying autoimmune disease with altered bowel habits, weight loss, or abdominal p





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American College of Gastroenterology Annual Scientific Meeting, October 20-25, 2023, Vancouver, Canada