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A case of adult-onset Satoyoshi syndrome with gastric ulceration and eosinophilic enteritis

Nature Clinical Practice Rheumatology volume 4, pages 439–444 (2008)Cite this article

Abstract

Background The patient was misdiagnosed as having Sjögren's syndrome (on the basis of a lower-limb rash and dry eyes and mouth) in 1999, and then as having systemic lupus erythematosus (on the basis of hair loss and a high antinuclear antibody titer) in 2005. Total alopecia, muscular spasms and diarrhea developed over the following 2 years, and the patient experienced gastric ulceration in 2006. A rheumatologic opinion was sought in 2007.

Investigations Physical examination, CBC, glucose tolerance test, iron studies, HLA typing, immunological investigations and complete gastrointestinal investigations, including gastroscopy, colonoscopy and small bowel biopsy.

Diagnosis Satoyoshi syndrome with autoimmune features (high levels of antinuclear antibody and antibodies to thyroid tissue) and malabsorption due to eosinophilic enteritis. This patient is only the fifth adult in the world reported to have Satoyoshi syndrome, and the first-reported adult case from South Africa.

Management The patient had only a transitory response to glucocorticoid treatment. Complete amelioration of symptoms resulted on two occasions when treated with intravenous immunoglobulin; however, the remissions only lasted for 6–8 weeks. More-intensive immunosuppression with azathioprine is currently being attempted.

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Figure 1: Patient with Satoyoshi syndrome showing alopecia totalis involving hair and eyebrows.
Figure 2: Analysis of the patient's esophagus, stomach and duodenum revealed signs of eosinophilic enteritis.

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Acknowledgements

With regret, we announce that RA Asherson passed away before the publication of this article. Dr Asherson proposed and wrote this article before his passing. Désirée Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. RA Asherson was Professor of Immunology (Hon) in the Division of Immunology, School of Pathology, University of the Witwatersrand, and a Consultant Rheumatologist at the Netcare Rosebank Hospital. D Giampaolo is a Consultant Neurologist and M Strimling is a Consultant Gastroenterologist at the Netcare Rosebank Hospital, Johannesburg, South Africa.,

    Ronald A Asherson, Dominic Giampaolo & Michael Strimling

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  1. Ronald A Asherson
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  2. Dominic Giampaolo
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  3. Michael Strimling
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Correspondence to Michael Strimling.

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Asherson, R., Giampaolo, D. & Strimling, M. A case of adult-onset Satoyoshi syndrome with gastric ulceration and eosinophilic enteritis. Nat Rev Rheumatol 4, 439–444 (2008). https://doi.org/10.1038/ncprheum0839

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