BMJ Case Reports 2017; doi:10.1136/bcr-2017-219467

Ascites in a patient with episodic angio-oedema and eosinophilia: thinking outside the box

  1. Georgios N Dalekos1
  1. 1 Department of Medicine and Research Laboratory of Internal Medicine, School of Medicine, University of Thessaly, Larissa, Greece
  2. 2 Department of Pathology, School of Medicine, University of Thessaly, Larissa, Greece
  1. Correspondence to Professor Georgios N Dalekos, dalekos{at}
  • Accepted 5 April 2017
  • Published 21 April 2017


Episodic angio-oedema with eosinophilia (EAE) or Gleich’s syndrome is a rare condition characterised by recurrent episodes of oedema and eosinophilia, accompanied by urticaria, fever and weight gain. The presence of ascites has not been reported so far. We report a 21-year-old Caucasian woman who presented with marked ocular oedema and ascites. Laboratory evaluation revealed marked eosinophilia. During the last 3 months, three episodes of facial and neck oedema were reported, which resolved spontaneously over a period of 3–5 days. The diagnosis of EAE was established after exclusion of secondary causes (infections, allergic reactions, collagen diseases, neoplasms) and clonal disorders associated with marked eosinophilia. Low-dose steroids resulted in eosinophil decrease and complete resolution of symptoms, including ascites. This case highlights that ascites can be a very rare manifestation of EAE particularly if other more frequent causes of ascites have been excluded and the clinical and laboratory findings are supportive of EAE.


  • Contributors GND and EIR had the original idea, designed the study and

    wrote the first draft of the manuscript. GND and GP were the principal treating physicians of the patient. EIR, GP and GND collected and summarised the published literature and data of the patient. MI made the pathological analysis and diagnosis. GND made the final critical revision of the manuscript for important intellectual content. All authors have seen and approved the final version of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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