A strange oculomotor palsy with eosinophilia

Area of Science:

• Neurology
• Rheumatology
• Internal Medicine

Background:

• Eosinophilic granulomatosis with polyangeitis (EGPA), formerly Churg-Strauss syndrome, is a rare systemic vasculitis.
• EGPA is characterized by asthma, eosinophilia, and systemic vasculitis, often affecting small to medium-sized vessels.
• Neurological manifestations in EGPA can be diverse and debilitating.

Purpose of the Study:

• To report a case of oculomotor palsy secondary to EGPA.
• To highlight the diagnostic challenges and treatment outcomes in a patient with EGPA presenting with neurological deterioration.

Main Methods:

• A 75-year-old male patient presented with a 2-month history of neurological deterioration, including oculomotor palsy.
• Diagnostic workup included blood tests revealing significant eosinophilia (6510 cells/µL) and cerebral MRI showing subcortical lesions with hemorrhage.
• Cerebral biopsy confirmed small vessel vasculitis with eosinophilic infiltration.

Main Results:

• The patient exhibited symptoms consistent with EGPA, including prior sinusitis, asthma, arthralgias, myalgias, and asthenia.
• Cerebral magnetic resonance imaging revealed bilateral frontal and left parietal subcortical lesions.
• Histopathological examination of the cerebral biopsy confirmed vasculitis, fibrinoid necrosis, and eosinophilic encroachment.

Conclusions:

• Oculomotor palsy can be a presenting neurological manifestation of eosinophilic granulomatosis with polyangeitis.
• Prompt diagnosis and combined immunosuppressive therapy with corticosteroids and cyclophosphamide are crucial for favorable outcomes in EGPA.
• This case underscores the importance of considering EGPA in patients with unexplained neurological deficits and prominent eosinophilia.