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Case Report
Eosinophilic granulomatosis with polyangiitis presenting with acute polyneuropathy resembling Guillain–Barre syndrome
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
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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 - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Youssef Benmoh - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Cedrick Moussavou - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Aziz Ahizone - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Ayoub Bakal - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Mohamed Ajamate - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Amal Satte - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Ahmed Bourazza - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors 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.
