2 Case Reports in Gastrointestinal Medicine Figure 1: Ascending colon inﬂammation. Figure 3: Coronal view and pelvic free ﬂuid. Interstitial eosinophilic inﬁltration Fibrinoid necrosis in mesenteric vessel Figure 2: Transverse colon inﬂammation. Other causes include ischaemic colitis, as well as inﬂam- matory bowel disease such as Crohn’s colitis and ulcerative colitis. Eosinophilic colitis (EC) is a rare cause of colitis; however, it may very occasionally present with haemorrhagic manifestations. Primary eosinophilic gastrointestinal disease (EGID) was ﬁrst described by Kaiser in 1937 [3]. It is a rare chronic inﬂammatory bowel condition of unknown etiology, characterized by inﬂammatory changes rich in eosinophils without evidence of other known causes of eosinophilia. This may aﬀect any segment of the gastrointestinal tract and presents in a myriad of diﬀerent manifestations. Causes of EC may be divided into 2 main groups, that is, those with primary and secondary causes. Primary eosinophilic colitis is the rarest manifestation of EGID, the other more common presentations being eosinophilic esophagitis and eosinophilic gastroenteritis [4]. The disease mainly aﬀects the paediatric population, although it has been reported in the adult population as well. The hallmarks of EC are peripheral eosinophilia, segmental eosinophilic colonic inﬁltration, and functional abnormalities [5]. Secondary Figure 4: Eosinophilic colitis histology. causes of EC include parasitic infection, inﬂammatory bowel disease, carcinoma, connective tissue disease, drug-related causes such as Rifampicin, Clozapine, and Carbamazepine, and vasculitic causes. Clinical presentation of the primary EC depends on the layer of intestinal wall that is inﬁltrated by eosinophils and correlates well with the physical symptoms and clinical ﬁndings. Mucosal predominant disease presents with diar- rhoea, protein wasting, and malabsorption [6]. Transmural disease is associated with thickened bowel, obstruction, perforation, volvulus, intussusception [7], and perforation [8]. Serosal involvement is characterized by presence of eosinophilic ascites [9]. However, there has been no report so far in the literature on eosinophilic colitis presenting with haemorrhagic colitis. The diagnosis of EC is made via the presence of symp- toms, peripheral eosinophilia, endoscopic or histological ﬁndings, and eosinophilic ascitis, with exclusion of all other causes of secondary eosinophilia. Histological ﬁndings show eosinophilic inﬁltrates throughout the lamina propria,