[A case of polyangiitis overlap syndrome]

Area of Science:

• Internal Medicine
• Pathology
• Rheumatology

Background:

• Polyangiitis overlap syndrome is a rare systemic vasculitis characterized by inflammation of blood vessels.
• Eosinophilia and elevated IgE levels can be associated with certain types of vasculitis, including eosinophilic granulomatosis with polyangiitis.

Observation:

• A 47-year-old male presented with fever, severe epigastric pain, significant eosinophilia (9,812/microliter), and elevated serum IgE (934 IU/ml).
• Diagnostic imaging revealed multiple hemorrhagic gastric ulcers and a left adrenal tumor.
• Gastric ulcers were refractory to conservative management, necessitating total gastrectomy and left adrenalectomy.

Findings:

• Histopathological examination of surgical specimens showed necrotizing angiitis with eosinophilic infiltration and thrombus formation in both the stomach and adrenal gland.
• Persistent eosinophilia despite corticosteroid and immunosuppressant therapy was noted.
• The patient subsequently developed polymononeuropathy in the lower limbs and necrotizing toe lesions, resistant to medical treatment and ganglionic blockade.

Implications:

• The clinical presentation and pathological findings supported a diagnosis of polyangiitis overlap syndrome, with features overlapping Allergic Granulomatosis and Polyarteritis Nodosa.
• This case highlights the complex and potentially severe gastrointestinal and systemic manifestations of eosinophilic vasculitis.
• The refractoriness to initial treatments underscores the challenges in managing this rare condition and the need for further research into therapeutic strategies.