{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:13:12Z","timestamp":1790183592897,"version":"4.1.0"},"reference-count":15,"publisher":"Department of Medicine, Warren Alpert Medical School at Brown University","issue":"4","license":[{"start":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T00:00:00Z","timestamp":1727740800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>\n                    We highlight a case of non-infectious diarrhea that progressed despite supportive care, prompting further workup. A 50-year-old man presented with 1 week of voluminous diarrhea, nausea, emesis, and abdominal pain. His history included ulcerative colitis, primary sclerosing cholangitis,\n                    <jats:italic>Clostridioides difficile<\/jats:italic>\n                    treated via total colectomy with ileoanal pouch, treated disseminated\n                    <jats:italic>Mycobacterium avium<\/jats:italic>\n                    complex, and international travel. On physical exam he had normal vital signs, diffuse abdominal tenderness without peritoneal signs, and a rash. Lab work revealed leukocytosis with eosinophilia, hyponatremia, and elevated creatinine. Lactate, inflammatory markers, stool studies, and computed tomography of his abdomen were normal. Tissue biopsies of the duodenum, ileum, and rectal pouch collected during colonoscopy and push enteroscopy revealed prominent mucosal eosinophilia, confirming the diagnosis of hypereosinophilic syndrome (HES). Treatment with steroids led to significant improvement in all symptoms and blood eosinophilia. This case highlights the importance of aggressive workup of diarrhea with peripheral eosinophilia, especially in patients with ulcerative colitis: waiting 6 months to confirm the diagnosis via blood work would delay treatment. Notably, infection with\n                    <jats:italic>Strongyloides\u202fstercoralis<\/jats:italic>\n                    was ruled out in this case prior to treatment. This is an important step in the workup and management of HES to prevent progression of Strongyloidiasis.\n                  <\/jats:p>","DOI":"10.56305\/001c.122954","type":"journal-article","created":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T06:59:22Z","timestamp":1727765962000},"source":"Crossref","is-referenced-by-count":1,"title":["More Than Just Stool: Hypereosinophilic Syndrome Presenting as Persistent Diarrhea in a Patient With Ulcerative Colitis"],"prefix":"10.56305","volume":"3","author":[{"given":"Sarah F","family":"Gruber","sequence":"first","affiliation":[{"name":"Emory University School of Medicine, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A","family":"Gallagher","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Emory University School of Medicine, Atlanta, GA, USA"},{"name":"Grady Health System, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8173-9824","authenticated-orcid":false,"given":"Manpreet S","family":"Malik","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Emory University School of Medicine, Atlanta, GA, USA"},{"name":"Grady Health System, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4188-4768","authenticated-orcid":false,"given":"Mary Ann Kikconnell","family":"Hall","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Emory University School of Medicine, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"35509","published-online":{"date-parts":[[2024,10,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.jaci.2010.04.011","article-title":"Practical approach to the patient with hypereosinophilia","volume":"126","author":"F. Roufosse","year":"2012","journal-title":"J Allergy Clin Immunol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1016\/j.jaci.2012.02.019","article-title":"Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes","volume":"130","author":"P. Valent","year":"2012","journal-title":"J Allergy Clin Immunol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.jaci.2010.03.042","article-title":"Refining the definition of hypereosinophilic syndrome","volume":"126","author":"H. Simon","year":"2010","journal-title":"J Clin Microbiol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1069","DOI":"10.1182\/blood-2014-11-551614","article-title":"How I treat hypereosinophilic syndromes","volume":"126","author":"A. 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Barr","year":"2014","journal-title":"Am Fam Physician"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1016\/s0002-9343(99)00128-x","article-title":"Acute diarrhea: a practical review","volume":"106","author":"J. Aranda-Michel","year":"1999","journal-title":"Am J Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"s190","DOI":"10.5005\/jp-journals-10071-23610","article-title":"Gastrointestinal Manifestations of Systemic Diseases in Critically Ill","volume":"24","author":"A. Panigrahy","year":"2020","journal-title":"Indian J Crit Care Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1380","DOI":"10.1136\/gutjnl-2017-315909","article-title":"Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition","volume":"67","author":"R. Arasaradnam","year":"2018","journal-title":"Gut"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/1750-1172-2-37","article-title":"Hypereosinophilic syndromes","volume":"2","author":"F. Roufosse","year":"2007","journal-title":"Orphanet J Rare Dis"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1159\/000527380","article-title":"Hypereosinophilic Syndrome Secondary to Ulcerative Colitis and Primary Sclerosing Cholangitis","author":"D. V. Ramos","year":"2023","journal-title":"Case Rep Gastroenterol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1007\/s10620-012-2329-7","article-title":"Recurrent blood eosinophilia in ulcerative colitis is associated with severe disease and primary sclerosing cholangitis","volume":"58","author":"A. Barrie","year":"2013","journal-title":"Dig Dis Sci"},{"issue":"9","key":"ref15","doi-asserted-by":"publisher","first-page":"6771","DOI":"10.3748\/wjg.14.6771","article-title":"Adult eosinophilic gastroenteritis and hypereosinophilic syndromes","volume":"14","author":"H. Freeman","year":"2008","journal-title":"World J Gastroenterol"}],"container-title":["Journal of Brown Hospital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/bhm.scholasticahq.com\/article\/122954-more-than-just-stool-hypereosinophilic-syndrome-presenting-as-persistent-diarrhea-in-a-patient-with-ulcerative-colitis","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:18:29Z","timestamp":1789485509000},"score":1,"resource":{"primary":{"URL":"https:\/\/bhm.scholasticahq.com\/article\/122954-more-than-just-stool-hypereosinophilic-syndrome-presenting-as-persistent-diarrhea-in-a-patient-with-ulcerative-colitis"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,1]]},"references-count":15,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.56305\/001c.122954","relation":{},"ISSN":["2994-5593"],"issn-type":[{"value":"2994-5593","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,1]]}}}