case_images: PMC11785460_01
case_images: Contrast-enhanced CT scan illustrating duodenal wall thickening (A) and (B) axial contrast-enhanced CT image shows circumferential wall thickening in the duodenum (indicated by the star).
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case_images: PMC11785460_01_cureus-0017-00000076721-i01.jpg
case_images: FIG1
case_images: However, his symptoms persisted, and therefore, a contrast-enhanced computed tomography of the abdomen and pelvis was done, which revealed circumferential wall thickening involving the stomach and the first part of the duodenum (Figure 1).
case_images: Peripheral blood smear showing eosinophilia (Wright-Giemsa stain, 1,000x magnification). Peripheral blood smear revealing marked eosinophilia with abundant bi-lobed eosinophils.
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case_images: PMC11785460_01_cureus-0017-00000076721-i02.jpg
case_images: FIG2
case_images: The subsequent day hemogram revealed a total leukocyte count (TLC) of 11.3 x 109/L with eosinophil predominance (49.6%) and an absolute eosinophil count of 5.6 x 109/L (Figure 2).
case_images: Bone marrow aspirate illustrating marked eosinophilic hyperplasia with increased eosinophilic precursors (Wright-Giemsa stain, 1,000x magnification).
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case_images: PMC11785460_01_cureus-0017-00000076721-i03.jpg
case_images: FIG3
case_images: His bone marrow aspiration (Figure 3) and biopsy were suggestive of normocellular marrow with a prominence of eosinophils and eosinophil precursors (20% eosinophils, 22% myelocytes, and 16% metamyelocytes).
case_images: Ascitic fluid cytology with an eosinophilic predominance (Wright-Giemsa stain, 400x magnification)
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case_images: FIG4
case_images: Abdominal paracentesis was done, which revealed a low serum ascites albumin gradient (SAAG) (1.07), with a cell count of 4.48 x 109/L with 90% eosinophils (4.03 x 109/L, Table 3, Figure 4).