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Título

Eosinophilic granulomatosis with polyangiitis as a cause of polyneurradiculopathy

RESUMO

CASE PRESENTATION: Patient 57 years old, male, with a history of asthma and no other comorbidities, with a report of COVID in JUNE 2021 evolving about 2 weeks later with palpable purpuric lesions in the lower limbs associated with initial crural sensory-motor deficit insidious and progressive character. On admission, he had facial diparesis and areflex quadriparesis (grade IV-). In the clinical investigation, CSF collection was performed, which showed 05 cells and 35 proteins, electroneuromyography that came with suggestive signs of acute immune-mediated inflammatory polyneuroradiculopathy and axonal nature (AMSAN). Laboratory tests showed significant eosinophilia (> 5000), positive rheumatoid factor and anti-DNA, P-ANCA 1/40, protein electrophoresis with increased gamma globulin and alpha-1-globulin. Such findings close the diagnosis of Eosinophilic Granulomatosis with Polyangiitis (GEP). Imaging examinations showed pansinusopathy. During hospitalization, he underwent immunoglobulin for 5 days followed by pulse therapy with methylprednisolone, evolving with excellent clinical response and absence of eosinophilia. He is discharged with azathioprine and prednisone and remains asymptomatic in outpatient follow-up. DISCUSSION: PEG, formerly called Churg-Strauss disease, is a systemic necrotizing vasculitis of small and medium-sized vessels characterized by extravascular granulomas, eosinophilia and eosinophilic tissue infiltrate. The annual incidence is estimated at 1 to 3 cases in 1000,000 people. The mean age of onset is 48 years, with a slight predilection for females. According to the American College of Rheumatology criteria, of the 6 possible clinical criteria (asthma, eosinophilia greater than 10%, mononeuropathy or polyneuropathy, non-fixed pulmonary infiltrate, paranasal sinuses abnormality, biopsy with extravascular eosinophils) the patient had 5, confirming a case of PEG. FINAL COMMENTS: We present a case of a rare cause of polyneuropathy that had a good response after adequate therapy, showing the importance of including it among the hypotheses when the patient presents any of the suggestive symptoms for PEG, as it was diagnosed with early intervention, provides a significant improvement in the patient's quality of life and disease prognosis.

Palavras Chave

polyneurradiculopathy; Eosinophilic Granulomatosis with Polyangiitis; Churg-Strauss disease

Área

Neuropatias Periféricas