Intra-abdominal Mass, Obstructive Jaundice, and Eosinophilia

Area of Science:

• Internal Medicine
• Pathology
• Oncology

Background:

• Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis characterized by eosinophilia and asthma.
• EGPA commonly affects multiple organs including the lungs, skin, and nervous system.

Observation:

• A 48-year-old man presented with obstructive jaundice due to an intra-abdominal mass and elevated peripheral eosinophils.
• Initial biopsy revealed vasculitis and eosinophilic infiltration, leading to an EGPA diagnosis.

Findings:

• The patient showed an incomplete response to standard EGPA treatment (glucocorticoids and cyclophosphamide).
• A repeat biopsy six months later confirmed non-Hodgkin's lymphoma as the underlying diagnosis.

Implications:

• This case underscores the diagnostic challenges in differentiating EGPA from other eosinophilic disorders.
• It emphasizes the need for thorough evaluation and consideration of alternative diagnoses, such as lymphoma, especially in non-responsive cases.
• Accurate diagnosis is crucial for effective treatment and improved patient outcomes in complex cases presenting with eosinophilia and vasculitis.