Rapidly progressive neurologic symptoms can be alarming to both the patient and the clinician, given the concern for serious pathologies. In this case, a 67-year-old patient presents with painful sensorimotor symptoms that progress rapidly within days of onset. Proper localization and consideration of medical co-morbidities is essential for accurate diagnosis. This case highlights the importance of a detailed neurologic examination to aid in the localization and differential diagnosis. The case will take readers through a stepwise approach to this complex neurologic presentation, work-up and management.
NishiRKoikeHOhyamaK, et al.Differential clinicopathologic features of EGPA-associated neuropathy with and without ANCA. Neurology. 2020;94(16):11. doi:10.1212/wnl.0000000000009309
2.
KoikeHNishiROhyamaK, et al.Anca-associated vasculitic neuropathies: a Review. Neurology and Therapy. 2022;11(1):21-38. doi:10.1007/s40120-021-00315-7
von DeimlingMKoehlerTCFryeBCMaerker-HermannEVenhoffN. Two cases with new onset of anca-positive eosinophilic granulomatosis with polyangiitis under treatment with dupilumab: coincidence or causality?Ann Rheum Dis. 2022;82(4):580-582. doi:10.1136/ard-2022-223596
5.
HübnerCDietzAStremmelWStiehlAAndrassyK. Macrolide-induced churg-strauss syndrome in a patient with atopy. The Lancet. 1997;350(9077):563. doi:10.1016/s0140-6736(05)63139-x
6.
NakanoYSekinadaDMasudaG, et al.Clarithromycin-induced eosinophilic granulomatosis with polyangiitis: a case report. Respiratory Medicine Case Reports. 2023;44:101878. doi:10.1016/j.rmcr.2023.101878
7.
GreenRLVayonisAG. Churg-strauss syndrome after zafirlukast in two patients not receiving systemic steroid treatment. The Lancet. 1999;353(9154):725-726. doi:10.1016/s0140-6736(99)00565-6
8.
Le GallCPhamSVignesS, et al.Inhaled corticosteroids and Churg-strauss syndrome: a report of five cases. Eur Respir J. 2000;15(5):978-981. doi:10.1034/j.1399-3003.2000.15e29.x
9.
ChungSALangfordCAMazM, et al.2021 American college of rheumatology/vasculitis foundation guideline for the management of antineutrophil cytoplasmic antibody–associated vasculitis. Arthritis Rheumatol. 2021;73(8):1366-1383. doi:10.1002/art.41773
10.
KoikeHNishiRYagiS, et al.A review of Anti-IL-5 therapies for eosinophilic granulomatosis with polyangiitis. Adv Ther. 2023;40(1):25-40. doi:10.1007/s12325-022-02307-x
