1. CASE 경희 의료원 소화기 내과 황보 영

2. 방 O 극 (M/20) adm ; 06-2-1 Epigastric discomfort o/s) remote; 수개월전 recent; 수일전 상기 환자는 anal bleeding 으로 국군대전병원 외래 내원 하여 anal hemorrhoids 로 진단 받고 06-1-16 에 hemorroidectomy 시행 받은 후 수개월전부터 intermittent epigastric discomfort 있던 중 수술 이후 증상 재발 및 혈액검사상 Hgb 12 g/dL check 되어 further evaluation 위해 외과에서 전과됨. Chief complaint Present illness

3. Past medical history DM/HTN/TB/hepatitis (-/-/-/-) Peptic ulcer (+) ; ’01-7 & 12 월 위궤양, 안동병원 ’05. 9 월 duodenal ulcer unremakable alcohol (+) ; social smoking (-) Family history Personal history

4. Review of system General fatigue(-) weight loss(-) fever/chill (-/-) Respiratory cough(-) sputum(-) dyspnea(-) Cardiac palpitation(-) chest discomfort(-) orthopnea(-) Gastrointestinal A/N/V/D/C(-/+/+/-/-) epigastric discomfort(+) hemorrhoids (+) melena (+) hematochezia (+) → (-) Neurology dizziness(-) tremor(-)

5. Physical examination V/S 120/80 mmHg – 62 / min – 18 / min – 36.5 °C Ht 170 Cm Bwt 65 kg BMI 22.5 General alert mentality not so ill-looking appearance Skin no rash & pigmentation Eye & ENT isocoric pupil with PLR (++/++) whitish sclerae not pale conjunctivae Abdomen soft and flat abdomen normoactive bowel sound no hepatosplenomegaly Td/RT(-/-)

6. Initial lab finding CBC/DC 5100/mm 3 – 10.3 g/dL – 32.8 % - 280,000/mm 3 (Seg. 52.6 %) MCV 68.8 fL MCHC 31. 4 % Chemistry TB/DB 0.9/0.3 mg/dL AST/ALT 19/18 IU/L ALP/GGT 58/93 IU/L Prot/Alb 7.0/4.1 g/dL Glucose 98mg/dL Amylase 63 IU/L BUN/Cr 11/0.5 mg/dL Na/K/Cl 139/4.5/110mmol UA WBC 2 /HPF RBC 0~1/HPF Protein (-)

7. Problem list # 1. Epigastic discomfort, gastric & duodenal ulcer history # 2. Hypochromic microcytic anemia # 3. s/p hemorrhoidectomy d/t hemorrhoids #1. Peptic ulcer disease #2. Anemia

8. Plan 1. Gastroscopy 2. Anemia study ferritin, TIBC, serum Iron, PBS stool exem

9. Lab finding Anemia study S- iron 46 μg/dL (60-200) TIBC 333 μg/dL (260-420) ferritin 5.08 ng/mL (17-39) stool occult blood (+) stool parasite egg (-) PBS RBC ) microcytic hypochromic anemia anisocytosis (++), poikilocytosis (+) WBC ) segmented neutrophils : 50.5% lymphocytes : 30.0% eosinophil : 14.0 % monocytes : 4.5 % basophil : 1.0 %

10. Initial gastroscopy

11. Gastric lymphoma Leiomyoma, GIST Gastric cancer r/o Zollinger-Ellison’s syndrome r/o Eosinophilic gastroenteritis 1.Gastrin 2.Ig E 3.Pathology 4.Abdominal CT Impression → 31.32 pg/ml ( < 150) → > 1000 IU/ml → diffuse wall thickening of gastric antrum and duodenum

12. F/U gastroscopy (5 일 후 )

14. 01 년 외부병원 치료 기록 1. 01 년 7 월 혈액 검사 소견 WBC 5400 /mm 3 Hb 7.4 g/dL Eosinophilia (12.2%, PBS) 내시경 및 조직 검사 소견 Active DU, irregular gastric mucosal lesion → biopsy : chronic superficial gastritis 2. 01 년 12 월 혈액 검사 소견 : Hb 15.0 g/dL 내시경 및 조직 검사 소견 DU scar, mucosal lesion at G-C side of low body → biopsy : Eosinophilic gastritis 2001-7 2006-2

15. Final diagnosis Eosinophilic gastritis  Definition 1. Presence of abnormal GI symptoms 2. Eosinophilic infiltration in 1 or more areas of the GI tract, defined as 20↑ eosinophils/HPF 3. Absence of identified cause of eosinophilia 4. Exclusion of eosinophilic involvement in organs other than the gut  Classification Mucosal / Muscularis/ Serosal form Eosinophilic gastritis  Definition 1. Presence of abnormal GI symptoms 2. Eosinophilic infiltration in 1 or more areas of the GI tract, defined as 20↑ eosinophils/HPF 3. Absence of identified cause of eosinophilia 4. Exclusion of eosinophilic involvement in organs other than the gut  Classification Mucosal / Muscularis/ Serosal form Eosinophilic gastritis, recur Anemia d/t chronic blood loss Eosinophilic gastritis, recur Anemia d/t chronic blood loss PO PDL 30 mg for 14 days

16. F/U gastroscopy (Post PDL 14 days )