Eosinophilic Granulomatosis With Polyangiitis: A Case Report

TL;DR

This case report describes a rare condition called EGPA in a 65-year-old man with asthma, highlighting the diagnostic process and treatment response.

Contribution

The paper adds a new clinical case of EGPA with detailed diagnostic reasoning to the limited literature on this rare disease.

Findings

The patient showed elevated eosinophils, ANCA titers, and inflammatory markers consistent with EGPA.

MRI and CT imaging revealed lung and sinus abnormalities, while nerve biopsy showed axonopathy and healed vasculitis.

Pulse dose steroids improved the patient's symptoms after other treatments failed.

Abstract

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of necrotizing small-to-medium vessel vasculitis that can be associated with antineutrophil cytoplasmic antibody (ANCA) positivity, asthma, and eosinophilia. We present the case of a 65-year-old male with a past medical history of asthma who presented to the emergency department with bilateral upper and lower extremity paresthesias, as well as right foot drop, persisting for a two-week duration. His lab work revealed leukocytosis of 20.6 K/uL with 12.36 K/uL of absolute eosinophils as well as elevated inflammatory markers with an erythrocyte sedimentation rate of 32 mm/hr and CRP of 7.3 mg/dL. Both c-ANCA and p-ANCA titers were also elevated at 1:320. An eventual MRI of the entire spine did not reveal any neurologic or anatomic lesions to explain the patient’s symptoms. CT imaging was also remarkable for airspace opacities involving the anterior right and bilateral lower posterior lung regions, as well as pansinusitis. A nerve biopsy showed axonopathy as well as evidence of healed vasculitis. Pulse dose steroids were started, which conferred benefits to the patient after other forms of treatment were unsuccessful. Given the rarity of EGPA, we think it is important to add new cases to the literature with a thorough discussion of the steps leading up to how the diagnosis was made.

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