PMID- 34433743
OWN - NLM
STAT- MEDLINE
DCOM- 20220328
LR  - 20220328
IS  - 1882-0654 (Electronic)
IS  - 0009-918X (Linking)
VI  - 61
IP  - 9
DP  - 2021 Sep 28
TI  - [Eosinophilic granulomatosis with polyangiitis presenting with Guillain-Barre 
      syndrome-like acute course. A case report].
PG  - 624-629
LID - 10.5692/clinicalneurol.cn-001601 [doi]
AB  - A 57-years-old man with a history of bronchial asthma and pansinusitis developed 
      acute progressive muscle weakness and sensory disturbance of the distal limbs 
      after upper respiratory infection. On day 15 after onset of sensory disturbance 
      and muscle weakness, the patient admitted to our hospital. A neurological 
      examination revealed asymmetry weakness of both proximal and distal muscles, 
      "glove and stocking type" hypoesthesia, and paresthesia without obvious pain. 
      Blood tests and a nerve conduction study demonstrated eosinophilia and elevation 
      of MPO-ANCA, axonal multiple mononeuropathy, respectively. The cerebrospinal 
      fluid was normal. Eosinophilic granulomatosis with polyangiitis (EGPA) or 
      Guillain-Barre syndrome (GBS) were suspected. So intravenous immunoglobulin 
      therapy (IVIg) and high dose methylprednisolone pulse therapy (HDMP) followed by 
      oral prednisolone were started. However, neurological symptoms did not improve. 
      Sural nerve biopsy on day 31 revealed varying myelinating fiber loss at every 
      nerve bundle and perivascular lymphocytic infiltration. The results did not 
      fulfill the pathologic criteria for EGPA, but supported the changes of 
      vasculitis. Cyclophosphamide (CPA) pulse therapy was administered for the 
      additional therapy. Neurological symptoms did not improve and worsened again 
      after decreasing oral prednisolone; therefore, combined therapy with IVIg, HDMP, 
      and CPA was administered. Neurological symptoms then diminished gradually and the 
      MPO-ANCA level and number of eosinophils normalized. This case suggests the 
      importance of early nerve biopsy to obtain pathological findings supportive of 
      EGPA diagnosis to allow introduction of aggressive immunosuppressive therapy such 
      as CPA in a case with acute progressive motor-sensory neuropathy due to EGPA 
      mimicking GBS.
FAU - Ueda, Ryota
AU  - Ueda R
AD  - Department of Neurology and Stroke Treatment, Kyoto Daiichi Red Cross Hospital.
FAU - Imai, Keisuke
AU  - Imai K
AD  - Department of Neurology and Stroke Treatment, Kyoto Daiichi Red Cross Hospital.
FAU - Yamamoto, Atsushi
AU  - Yamamoto A
AD  - Department of Neurology and Stroke Treatment, Kyoto Daiichi Red Cross Hospital.
FAU - Ioku, Tetsuya
AU  - Ioku T
AD  - Department of Neurology and Stroke Treatment, Kyoto Daiichi Red Cross Hospital.
FAU - Kadoya, Masatoshi
AU  - Kadoya M
AD  - Department of Rheumatology, Kyoto Daiichi Red Cross Hospital.
FAU - Hamanaka, Masashi
AU  - Hamanaka M
AD  - Department of Neurology, Kyoto Daini Red Cross Hospital.
LA  - jpn
PT  - Case Reports
PT  - Journal Article
DEP - 20210826
PL  - Japan
TA  - Rinsho Shinkeigaku
JT  - Rinsho shinkeigaku = Clinical neurology
JID - 0417466
RN  - 0 (Antibodies, Antineutrophil Cytoplasmic)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 9PHQ9Y1OLM (Prednisolone)
SB  - IM
MH  - Antibodies, Antineutrophil Cytoplasmic
MH  - *Churg-Strauss Syndrome
MH  - *Granulomatosis with Polyangiitis
MH  - *Guillain-Barre Syndrome/diagnosis
MH  - Humans
MH  - Immunoglobulins, Intravenous
MH  - Middle Aged
MH  - Muscle Weakness
MH  - Prednisolone
OTO - NOTNLM
OT  - Guillain-Barre syndrome
OT  - cyclophosphamide pulse therapy
OT  - eosinophilic granulomatosis with polyangiitis
OT  - intravenous immunoglobulin therapy
OT  - nerve biopsy
EDAT- 2021/08/27 06:00
MHDA- 2022/03/29 06:00
CRDT- 2021/08/26 05:38
PHST- 2021/08/27 06:00 [pubmed]
PHST- 2022/03/29 06:00 [medline]
PHST- 2021/08/26 05:38 [entrez]
AID - 10.5692/clinicalneurol.cn-001601 [doi]
PST - ppublish
SO  - Rinsho Shinkeigaku. 2021 Sep 28;61(9):624-629. doi: 
      10.5692/clinicalneurol.cn-001601. Epub 2021 Aug 26.