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The clinical course was characterised by chronic watery diarrhoea without weight loss, peripheral eosinophilia (11%) and colonoscopy revealing multiple submucosal polypoid lesions throughout the colon. Radiological imaging showed numerous crescent-shaped calcifications, consistent with longstanding quiescent pentastomiasis. Histopathology showed dense eosinophilic infiltration of the lamina propria without identifiable organisms, suggesting a possible recrudescent inflammatory response associated with residual parasite material rather than active infection. This case highlights the potential for extremely long latency periods and late recrudescence, presenting as eosinophilic colitis, underscoring the importance of considering rare parasitic aetiologies in patients with unexplained eosinophilic gastrointestinal disease, even in the absence of recent exposure.<\/jats:p>","DOI":"10.1136\/bcr-2025-271400","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T15:24:55Z","timestamp":1770737095000},"page":"e271400","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Eosinophilic colitis recrudescence two decades after initial pentastomiasis"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9908-3680","authenticated-orcid":false,"given":"Taned","family":"Chitapanarux","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanop","family":"Srisuwan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"2026021023551960000_19.2.e271400.1","unstructured":"Christoffrsen ML , Assis JE . 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