S3211 Eosinophilia: A Manifestation of Parasitic Infection or Ulcerative Colitis?
Bibliographic record
Abstract
Introduction: Ulcerative colitis is characterized by inflammation of the colon presenting with gastrointestinal symptoms and can also present with extraintestinal manifestations. One such manifestation that is prevalent in inflammatory bowel disease (IBD) cases is eosinophilia, but blood eosinophils seldom reach levels over 1500 cells/𝜇L1. We present a case of ulcerative colitis with a very high eosinophil count presenting as a hematologic extraintestinal manifestation. Case Description/Methods: A 34-year-old Saudi Arabian man presented for a colonoscopy with complaints of bloody stool and bilateral lower quadrant pain starting approximately 5 months prior. During this procedure, inflammation, friability and granularity were noted in the descending colon, sigmoid colon and rectum. His CBC revealed elevated eosinophil count with levels reaching 4,340 cells/𝜇L, and a differential of 28%. Biopsy of the descending colon showed no presence of eosinophils but did show cryptitis and architectural distortion consistent with IBD. Subsequent ova and parasite testing and review including histology for schistosomiasis and amebiasis were negative. Additional testing was performed including an ANA that was negative and calprotectin levels were very high consistent with ulcerative colitis. Liver function tests were normal as well. As a result of the combination of findings, the diagnosis of ulcerative colitis was made. Initial treatment with mesalamine was ineffective. However, upon treatment with vedolizumab he showed definitive clinical and endoscopic response, and his total eosinophil count normalized (Figure 1). Discussion: Worldwide, inflammatory bowel disease’s incidence has seen nearly a 50% increase over the last 30 years; however, reports of significant eosinophilia at the onset of symptoms remain relatively rare, especially with cell counts greater than 1500 cells/𝜇L1. Additionally, literature regarding treatment of such cases is limited. Although infrequent, eosinophilia can be a presenting sign of IBD. Thus, both Crohn's disease and ulcerative colitis should be included in the differential diagnosis in cases with gastrointestinal symptoms and elevated eosinophil levels, especially when parasitic infection has been ruled out. Reference 1. Barrie, Arthur et al. Recurrent blood eosinophilia in ulcerative colitis is associated with severe disease and primary sclerosing cholangitis. Digestive diseases and sciences vol. 58, 1 (2013): 222-8. doi:10.1007/s10620-012-2329-7Figure 1.: Benign ulcerated colonic mucosa with cryptitis and architectural distortion, taken from the descending colon.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.008 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".