SHM Converge Scientific Abstract ePoster Gallery-Eosinophilic Granulomatosis With Polyangiitis Presenting as Generalized Pain

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This case report describes a 65-year-old man with a complex medical history who presented with severe generalized pain after a recent tick bite and shingles. Despite initial treatment with prednisone for presumed autoimmune disease, he rapidly deteriorated with hypoxemic respiratory failure, abdominal pain, ischemic stroke, acute kidney injury, and small bowel obstruction progressing to full-thickness bowel necrosis requiring surgery.<br /><br />The diagnostic workup showed elevated inflammatory markers, leukocytosis, hyponatremia, and positive c-ANCA with myeloperoxidase antibodies. TEE did not support an embolic source for the stroke. Pathology from the resected bowel demonstrated microscopic vasculitis of small arteries and arterioles with fibrinoid necrosis and inflammatory infiltration by mononuclear cells and eosinophils, supporting a diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA), though the presentation was atypical because classic findings such as asthma, allergic rhinitis, and marked eosinophilia were not emphasized.<br /><br />He was treated with high-dose IV methylprednisolone, followed by a prednisone taper and monthly cyclophosphamide. He also received doxycycline for the tick bite and valacyclovir for shingles. The report highlights that EGPA can present in unusual and severe ways, including generalized pain, stroke, bowel ischemia/necrosis, and renal failure, which can delay diagnosis. It emphasizes the importance of a thorough evaluation, early recognition, prompt immunosuppressive treatment, and close follow-up to improve outcomes and monitor for complications.

Asset Subtitle

Hari Anandarajah

Meta Tag

Author List Andrew L. DeGroot, Antoni Wojtkowski, Devesh Kumar, Hari Anandarajah, Pinky Jha

Category Clinical Vignettes

Concept Eosinophilic Granulomatosis with Polyangiitis

Concept Vasculitis

Concept Eosinophil-Rich Infiltrate

Concept Antineutrophil cytoplasmic antibody

Concept Granulomatosis with Polyangiitis

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Hari Anandarajah

Track Adult

Keywords

eosinophilic granulomatosis with polyangiitis

EGPA

vasculitis

bowel necrosis

ischemic stroke

acute kidney injury

hypoxemic respiratory failure

tick bite

shingles

cyclophosphamide

Eosinophilic Granulomatosis with Polyangiitis

Vasculitis

Eosinophil-Rich Infiltrate

Antineutrophil cytoplasmic antibody

Granulomatosis with Polyangiitis