MarkedEosinophiliaina27-Year-OldWomanwithRecentOnsetUlcerativeColitis
Question:A27-year-oldfemaleofAsianIndiandescentandnosignificantmedicalhistoryandonnomedicationswasreferredfor2monthsofbloodydiarrheaassociatedwithlowerabdominalcrampingand10-lbweightloss.HerhistorywasotherwiseremarkablefortraveltoIndiaseveralyearspriorandworkasaclinicalresearcherinthebonemarrowtransplantunit.Clinicalexamwasunremarkable.Laboratorystudiesdemonstratedanalkalinephosphatase(AP)ofU/L,alanineaminotransferase(ALT)of55U/L,aspartateaminotransferase(AST)of41U/L,normalbilirubin,leukocytecount28X/cmm(34%eosinophils)andsignificantlyelevatedfecalleukocytes,erythrocytesedimentationrateandC-reactiveprotein.Colonoscopyandbiopsieswereconsistentwithchronicactiveulcerativepancolitis.Afterlackofresponsetomesalamineandbudesonide,shehada