SESSION TITLE: Pulmonary Manifestations of Systemic Disease Case Report Posters
SESSION TYPE: Affiliate Case Report Poster
PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM
INTRODUCTION: Hemorrhagic stroke is an uncommon manifestation of eosinophilic granulomatosis with polyangiitis. We present a case of altered mental status in a patient with sinusitis and asthma.
CASE PRESENTATION: The patient is a 57 year old Egyptian woman with past medical history of asthma, CHF, DM, HTN, and ischemic CVA who presented to the ED with a chief complaint of altered mental status. CT of the head showed intraventricular hemorrhage and sinusitis. Of note, she was discharged the previous day after treatment for community acquired pneumonia confirmed by the presence of bilateral infiltrates on chest imaging. Cerebral angiogram showed a fusiform aneurysm from a branch of the left posterior cerebral artery, which was too small for endovascular intervention. Debridement of the sinuses was performed and biopsy showed numerous eosinophils and lymphoplasma cells. Peripheral eosinophilia (40%) was noted. Infectious work up was negative. Inflammatory work up revealed positive p-ANCA. A diagnosis of eosinophilic granulomatosis with polyangiitis was made based on ACR guidelines and the patient was treated with systemic corticosteroids.
DISCUSSION: Eosinophilic granulomatosis with polyangiitis is a small and medium vessel vasculitis characterized by chronic rhino-sinusitis, asthma, and peripheral blood eosinophilia. Neurologic effects are common and usually include mononeuritis multiplex or sensorimotor peripheral neuropathy (1). CNS involvement is unusual and often presents as ischemic infarction or encephalopathy (1,2). Hemorrhagic stroke is rare with few reports in the literature of subarachnoid hemorrhage, intracerebral hemorrhage, and recurrent spinal SAH (2). To date, there is one case report of SAH and intraventricular hemorrhage caused by necrotizing vasculitis of the choroid plexus (3).
CONCLUSIONS: This is a rare case of a patient with a long history of asthma and sinusitis presenting with intraventricular hemorrhage precipitated by vasculitis associated with eosinophilic granulomatosis with polyangiitis.
Reference #1: Abril A. Churg-strauss syndrome: an update. Curr Rheumatol Rep. 2011 Dec;13(6):489-95.
Reference #2: Mencacci et al. Intracerebral haemorrhage, a possible presentation in Churg-Strauss syndrome: case report and review of the literature. J Neurol Sci. 2011 Feb 15;301(1-2):107-11.
Reference #3: Chang et al. Intraventricular and subarachnoid hemorrhage resulting from necrotizing vasculitis of the choroid plexus in a patient with Churg-Strauss syndrome. Clin Neuropathol. 1993 Mar-Apr;12(2):84-7.
DISCLOSURE: The following authors have nothing to disclose: Lauren Blackwell, Rahim Wooley, Lauren Koniaris
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