Eosinophilic gastroenteritis in a 45-year-old female with epigastric abdominal pain: a rare case report

Introduction and importance: Eosinophilic gastroenteritis (EGE) is a rare condition characterized by eosinophilic infiltration of the gastrointestinal tract, commonly presenting with abdominal pain, diarrhea, and peripheral eosinophilia. Corticosteroids are traditionally considered the mainstay of treatment. Case presentation: A 45-year-old female presented with epigastric abdominal pain. Laboratory tests revealed marked peripheral eosinophilia, and upper endoscopy with biopsies confirmed mucosal-type EGE. The patient declined corticosteroid therapy and was commenced on montelukast 10 mg daily. She achieved complete symptom resolution within 2 weeks and maintained remission over a 12-month follow-up. Clinical discussion: Corticosteroids remain the standard treatment for EGE, effectively reducing eosinophil counts and inflammatory mediators. In patients unable or unwilling to receive steroids, leukotriene receptor antagonists, such as montelukast, offer a viable alternative, demonstrating rapid symptom relief and potential for sustained remission. Conclusion: Physicians should recognize EGE and its therapeutic complexities. Montelukast may serve as an effective corticosteroid-sparing strategy, enabling early symptom resolution and long-term remission.