We present a 42-year-old Caucasian female who was admitted for an allergy investigation. She had been experiencing persistent colicky abdominal pain with associated constant diarrhea and weight loss, along with peripheral eosinophilia for 8 weeks. Pertinent labs on admission showed: white blood cell count 10.07 × 103, hemoglobin 12.9 g/dl, MCV 86.6 fl, absolute eosinophil count of 3,090 cells/ml (30%), normal liver function tests, normal lipase levels and low levels of serum IgE.
Methods:
The gastroscopic test did not show any abnormalities. Samples for biopsy were not taken.
Ultrasonography results for the upper and lower abdomen were normal. Stool studies for ova and parasites were negative.
The patient had a history of allergic rhinitis, conjunctivitis and asthma due to mites, grasses and cereal pollen. She had undergone successful desensitization therapy which had been completed three years before. She had no known history of allergies to foods.
Skin prick tests to foods were performed afterwards and prick to prick skin testing with Goji berries as she had been eating 10-20 Goji berries per day during the last few months. Delayed- type hypersensitivity tests (atopy patch tests) to common foods were also performed.
The allergy testing showed immediate type sensitivity-allergy (grade IV) to Goji berries , and a delayed –type sensitivity (grade II) to egg .
Results:
After the patient followed a diet avoiding the suspicious the symptoms subsided and disappeared (on the 7th day of the diet). On the 20thth day of the diet blood tests were performed and it was found that the number of eosinophils in peripheral blood was within normal levels (white blood cell count 7.39 × 103,absolute eosinophil count of 290 cells / ml (3.9%).
Four months later, and as the patient was asymptomatic we introduced eggs into her diet. There were no symptoms or increase in the number of eosinophils.
Two years later the patient remained asymptomatic.
Conclusions:
We present this case as it is the first case of hypereosinophilia and symptoms of eosinophilic gastroenteritis due to goji berry ingestion .
The reason we mention the symptoms is that, despite our strong suspicion, there was no histological confirmation as in the initial gastroscopy biopsy specimens were never obtained.
Moreover, we would like to emphasize that the detailed history and thorough allergy testing can, in some cases, help resolve these situations without strenuous tests and prolonged use of cortisone.