Case Report


Eosinophilic granulomatosis with polyangiitis presenting with acute polyneuropathy resembling Guillain–Barre syndrome

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1 Department of Neurology, Mohamed V Military Teaching Hospital, Mohamed V University, Rabat, Morocco

2 Department of Neurophysiology, Mohamed V Military Teaching Hospital, Mohamed V University, Rabat, Morocco

Address correspondence to:

Mohamed Hamid

Department of Neurology, Mohamed V Military Teaching Hospital, Mohamed V University, Rabat,

Morocco

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Article ID: 101282Z01MH2022

doi: 10.5348/101282Z01MH2022CR

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How to cite this article

Hamid M, Benmoh Y, Moussavou C, Ahizone A, Bakal A, Ajamate M, Satte A, Bourazza A. Eosinophilic granulomatosis with polyangiitis presenting with acute polyneuropathy resembling Guillain–Barre syndrome. Int J Case Rep Images 2022;13:101282Z01MH2022.

ABSTRACT


Introduction: Eosinophilic granulomatosis with polyangiitis (EGPA) is defined as a small- and medium-sized artery necrotizing vasculitis associated with asthma, eosinophilia, and extra neurologic granulomatosis (lung, cardiac, kidney, and skin). We report a case of EGPA with Guillain–Barre syndrome (GBS) like presentation.

Case Report: A 37-year-old man with a history of asthma was admitted for rapidly progressive symmetric flaccid areflexic tetraparesis, peripheral facial palsy, proprioceptive hypoesthesia, and thigh skin purpuric lesions. Electroneuromyography study revealed demyelinating sensory motor polyneuropathy with secondary axonal loss. Cervical MRI, cerebrospinal fluid study, and paraclinical tests were normal. Complete blood count showed hypereosinophilia and elevated erythrocyte sedimentation. Electrocardiogram and transthoracic echocardiography were normal. Spirometry revealed obstructive syndrome. Chest and paranasal sinus computed tomography (CT) demonstrated ground-glass opacities and severe pansinusitis. Skin biopsy showed necrotizing vasculitis with eosinophils and antineutrophil cytoplasmic antibody (ANCA) was negative. Clinical, laboratory, and radiologic findings met the American College of Rheumatology (ACR) EGPA criteria. The patient was treated by methylprednisolone bolus and cyclophosphamide with sensory motor recovery and no systemic relapse with 10 months follow-up.

Conclusion: Eosinophilic granulomatosis with polyangiitis may be revealed by a GBS mimicking presentation. Neurologic system can be involved in the ANCA negative EGPA. Paraclinical tests should be performed in GBS presentation to make accurate diagnosis and early treatment.

Keywords: Asthma, Eosinophilic granulomatosis with polyangiitis, Guillain–Barre syndrome, Hypereosinophilia

SUPPORTING INFORMATION


Author Contributions

Mohamed Hamid - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Youssef Benmoh - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Cedrick Moussavou - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Aziz Ahizone - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Ayoub Bakal - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Mohamed Ajamate - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Amal Satte - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Ahmed Bourazza - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Guarantor of Submission

The corresponding author is the guarantor of submission.

Source of Support

None

Consent Statement

Written informed consent was obtained from the patient for publication of this article.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Conflict of Interest

Authors declare no conflict of interest.

Copyright

© 2022 Mohamed Hamid et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.