Giardia lamblia infection as a possible cause of eosinophilic ascites and enterocolitis

Eosinophilic ascites is rarely observed in clinical practice and uncommonly related to parasitic infections. It may also be associated with subserosal type of eosinophilic gastroenteritis, peritoneal dialysis, lymphomas, and hypereosinophilic syndrome. A 45-year-old, previously healthy, male was admitted to the hospital complaining of abdominal pain, watery diarrhea with mucus (4-5 times per day) and fever lasting for 20 days. The patient denied taking any drugs or herbal medicine. He had no history of atopy or food allergy. His body temperature was 37.5 °C. Physical examination revealed mild abdominal distention with shifting dullness. The laboratory evaluation was significant for a white blood cell count of 26,700/mm3 , with 67% eosinophils, and normal serum chemistries. The sedimentation rate was 10 mm/h and CRP 1.5 mg/dL. The titres of auto-antibodies were negative as well as serology for Toxocara canis, Toxoplasmosis, Fasciolasis, Leishmaniasis, and Echinococcus granulosus. Total IgE value was normal. FIP1L1-PDGFRA gene mutation (which is often associated with idiopathic hypereosinophilic syndrome) was negative.