Eosinophilic granulomatosis with polyangiitis

Case contributed by Dr Fabien Ho

Presentation

Past history of asthma and sinonasal polyps. Non-smoker. Known stables pulmonary nodules without PET uptake for 3 years. Subacute dyspnea. Peripheral eosinophilia on bloodwork.

Patient Data

Age: 60 years
Gender: Male

Peripheral consolidation / ground glass opacity and solid centrilobular nodules (non cavitated).

3 months later, after antibiotics treatment

ct

Persistent peripheral consolidation / ground glass opacity and solid centrilobular nodules (non cavitated), except the left part which underwent slight changes with now a moderate pleural effusion. There is no obvious migratory consolidation/GGO.

Case Discussion

Chronic consolidation which does persist after standard antibiotics must raise suspicions for inflammatory disease, or lymphoma or bronchioloalveolar carcinoma.

In this patient, the peripheral consolidation/GGO pattern had favored the diagnosis towards chronic eosinophilic lung. However, the additional nodules indicated a likely associated granulomatosis, hence, with all clinical (asthma, sinonasal polyps) and lab elements (peripheral eosinophilia) the most likely diagnosis was eosinophilic granulomatosis with polyangiitis (previously known as Churg-Strauss syndrome).

Organized pneumonia was considered unlikely: lack of migratory elements, no reversed halo sign.  Granulomatosis with polyangiitis (Wegner granulomatosis) usually features cavitated nodules and the consolidation does not have a peripheral pattern.

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