Eosinophilic Gastroenteritis With Ascites in a Young Adult: A Diagnostic Challenge

Eosinophilic gastroenteritis (EGE) is a rare gastrointestinal disorder characterised by eosinophilic infiltration of the gastrointestinal tract and associated with peripheral eosinophilia.Clinical presentation is variable and often nonspecific, while the absence of standard diagnostic criteria can contribute to diagnostic challenges.We present the case of a 24-year-old male with a two-year history of recurrent nonspecific gastrointestinal symptoms, who presented with severe abdominal pain, nausea, vomiting, and ascites.Investigations demonstrated marked peripheral eosinophilia, raised inflammatory markers, bowel wall thickening, and ascites.Histological examination of gastric and terminal ileal biopsies demonstrated gastrointestinal eosinophilic infiltration, supporting a diagnosis of EGE.The patient was treated with corticosteroids and dietary modification, with rapid resolution of symptoms and complete resolution of ascites at one-month follow-up.This case highlights the importance of considering EGE in young patients presenting with recurrent or persistent gastrointestinal symptoms, particularly when accompanied by peripheral eosinophilia and unexplained ascites.It also emphasises the importance of reconsidering an initial diagnosis when symptoms do not follow the expected course of a self-limiting illness and maintaining a broad differential diagnosis to facilitate timely investigation and management.