From Nerves to Vessels: Unmasking Churg-Strauss Behind Polyneuropathy

Eosinophilic granulomatosis with polyangiitis (EGPA), formerly Churg-Strauss vasculitis, is a rare systemic autoimmune disease. Neurological involvement is a significant complication. This report details a case of EGPA with severe, progressive polyneuropathy and atypical serological findings, highlighting diagnostic challenges and the importance of early intervention. A 55-year-old male with asthma and uncontrolled diabetes presented with progressive neuropathic pain and paraplegia. He had a history of significant eosinophilia. Clinical examination revealed a rash, neurological deficits, and signs of multisystem involvement. Laboratory tests showed marked eosinophilia, elevated inflammatory markers, renal impairment, and positive ANCA. Imaging revealed cerebral ischemic changes and small vessel vasculitis. A skin biopsy confirmed leukocytoclastic vasculitis, and echocardiography showed cardiac dysfunction. The constellation of symptoms led to a diagnosis of EGPA with multisystem involvement. This case illustrates the classic triad of EGPA symptoms: asthma, hypereosinophilia, and multisystem involvement, particularly neurological. The patient's progressive neurological symptoms and positive ANCA supported the diagnosis of CNS vasculitis. The rapid onset of neurological involvement, despite the patient's age and delayed diagnosis, underscores the aggressive nature of EGPA. The multisystem involvement, including cardiac and renal systems, highlights the need for a comprehensive diagnostic and therapeutic approach. Early diagnosis and aggressive immunosuppressive therapy are crucial for preventing irreversible damage. The atypical finding of c-ANCA positivity, rather than the more common p-ANCA, presents a diagnostic challenge and warrants further investigation into specific ANCA subtypes (MPO vs. PR3). This case emphasizes the need for a high index of suspicion for EGPA in patients with unexplained neurological symptoms, especially those with asthma or hypereosinophilia, even in the presence of unusual serological markers. EGPA is a complex disease with diverse neurological and systemic manifestations. This case emphasizes the importance of early recognition and prompt treatment with corticosteroids and immunosuppressive agents to improve patient outcomes and prevent long-term sequelae. Clinicians should consider EGPA in patients with unexplained neurological symptoms, especially those with a history of asthma or hypereosinophilia.