2023 Volume 69 Issue 4 Pages 284-291
We herein report a case of eosinophilic granulomatosis with polyangiitis (EGPA) following the onset of vasculitis symptoms approximately two weeks after surgery for eosinophilic chronic rhinosinusitis (ECRS). A 61-year-old man presented with a complaint of nasal obstruction, and bilateral nasal polyps were found in the nasal cavity. We diagnosed his with ECRS with a Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) score of 17 points and performed bilateral endoscopic sinus surgery (ESS). The patient was discharged from the hospital with a good postoperative course, but about two weeks after surgery, he developed a fever, diarrhea, arthralgia, and bilateral leg edema, Laboratory data indicated acute renal failure and severe eosinophilia. He was hospitalized and received a skin biopsy from the purpura on his lower extremities. Pathological examinations revealed vasculitis with eosinophilic infiltration. After receiving a diagnosis of EGPA, he was treated with steroid pulse therapy and intravenous cyclophosphamide (IVCY), and all of his symptoms resolved rapidly. He has been in remission for 17 months since treatment without any persistent symptoms. When examining patients with ECRS, it is important to keep in mind the possibility of underlying EGPA and to monitor systemic symptoms for an early diagnosis and intervention.
