SHM Converge Scientific Abstract ePoster Gallery-An Elusive Egpa Diagnosis Complicated by Steroid Induced Glaucoma

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This case describes a 41-year-old man with a 10-year history of recurrent sinusitis, asthma, chronic nephrolithiasis, and steroid-induced open-angle glaucoma who presented with pleuritic chest pain and dyspnea. His evaluation showed leukocytosis and CT imaging concerning for multilobar pneumonia, but infectious studies were negative. Bronchoscopy revealed copious green mucus plugging, inflamed airways, persistent right middle and lower lobe infiltrates, and bronchoalveolar lavage with 58% eosinophils. After antibiotics were stopped, rheumatology and allergy/immunology diagnosed eosinophilic granulomatosis with polyangiitis (EGPA).<br /><br />EGPA is a small- to medium-vessel granulomatous vasculitis with unclear pathogenesis, often linked to abnormal immune activity. It typically progresses through prodromal, eosinophilic, and vasculitic phases. Diagnosis is traditionally based on American College of Rheumatology criteria, where four of six features strongly support the disease: eosinophilia, asthma, neuropathy, paranasal sinus abnormality, extravascular eosinophils, and non-fixed pulmonary infiltrates. In this patient, the combination of asthma, chronic sinus disease, transient pulmonary infiltrates, and marked eosinophils in BAL fluid was sufficient to confirm EGPA, even without peripheral eosinophilia.<br /><br />Because glucocorticoids are the standard initial treatment for EGPA but had previously caused glaucoma in this patient, clinicians avoided steroids and started rituximab instead. The case emphasizes that EGPA can present atypically, peripheral eosinophilia is not always required, and alternative therapies such as rituximab may be important when steroids are contraindicated.

Asset Subtitle

John C. Weis

Meta Tag

Author List Jay Anderson, John C. Weis, Pavithra Kannan

Category Clinical Vignettes

Concept Eosinophilic Granulomatosis with Polyangiitis

Concept American College of Rheumatology Diagnostic Criteria

Concept Peripheral Eosinophilia

Concept Bronchoalveolar Lavage

Concept Corticosteroid

Distinguished Non-Finalist

Presenter Organization OhioHealth Riverside Methodist Hospital

Presenting Author John C. Weis

Track Adult

Keywords

eosinophilic granulomatosis with polyangiitis

EGPA

asthma

chronic sinusitis

eosinophilic pneumonia

bronchoalveolar lavage

pulmonary infiltrates

vasculitis

rituximab

glucocorticoid contraindication

Eosinophilic Granulomatosis with Polyangiitis

American College of Rheumatology Diagnostic Criteria

Peripheral Eosinophilia

Bronchoalveolar Lavage

Corticosteroid