Case Report 173

Eosinophilic Esophagitis as Paraneoplastic Syndrome in a Patient with Ganglioneuroblastoma

Authors

S. Prader1, J. Spalinger3, J. Caduff4, S. Hürlimann5, J. Rischewski2

Affiliations

Affiliation addresses are listed at the end of the article

Key words ▶ ganglioneuroblastom ● ▶ eosinophilic esophagitis ● ▶ paraneoplastic syndrome ● ▶ chronic diarrhea ●

Abstract

Schlüsselwörter ▶ Ganglioneuroblastom ● ▶ eosinophilie Ösophagitis ● ▶ paraneoplastisches Syndrom ● ▶ chronische Diarrhoe ●



A 16-month-old boy presented with failure to thrive despite sufficient caloric intake, hypersalivation, abdominal pain, chronic diarrhea and blepharitis. An eosinophilic esophagitis (EoE) was diagnosed by esophageal biopsy. Diet­ary restrictions and topical steroid treatment lead to no improvement. Further diagnostic work-up

Case report



Bibliography DOI http://dx.doi.org/ 10.1055/s-0035-1547307 Klin Padiatr 2015; 227: 173–175 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0300-8630 Correspondence Dr. Seraina Prader Immunology University Children’s Hospital Zurich Steinwiesstrasse 75 8032 Zurich Switzerland Tel.:  + 41/442/667 148 Fax:  + 41/442/667 171 [email protected]

The 16-month-old boy presented with stagnation of weight-gain (8 kg (P 3), 72 cm (P 3)) , abdominal pain, chronic diarrhoea, hypersalivation and blepharitis since the introduction of solid food. A first evaluation showed milk protein intolerance by moderately elevated milk-IgE. Despite adequate diet, the patient’s condition did not change, therefore an upper and lower endoscopy was performed at the age of 17 month. The esophageal biopsies showed a significant increase in numbers of eosinophils, with an average of 20 eosinophils/high power field (HPF) ▶  Fig. 1). Basal layer hyperplasia and fibrosis of ( ● the lamina propria was present, thus fulfilling the diagnostic criteria for eosinophilic esophagitis (EoE) [3]. Biopsies of the duodenum, the sigmoid colon and the rectum showed no eosinophilic infiltration. Topical treatment with budenosid and continuation of cow's milk protein free diet showed no improvement. Watery diarrhoea and abdominal pain persisted. The patient developed hypokalemia (potassium 2.8 mmol/L) and mild metabolic acidosis (pH 7.34) with low bicarbonate (14.9 mmol/L). An abdominal sonography showed a paraspinal mass which was confirmed by chest X-ray. Transaminases, creatinine and differential blood count were normal. Urinalysis showed elevated catecholamines: homovanillic acid 67.5 nmol/umol creatinine ( 

Eosinophilic esophagitis as paraneoplastic syndrome in a patient with ganglioneuroblastoma.

A 16-month-old boy presented with failure to thrive despite sufficient caloric intake, hypersalivation, abdominal pain, chronic diarrhea and blepharit...
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