2022 Volume 115 Issue 11 Pages 967-973
Background: We reported the clinical course of a rare case with eosinophilic granulomatosis with polyangiitis (EGPA) after surgery for eosinophilic sinusitis (ECRS).
Case presentation: The patient, diaganosed as a case of ECRS (JESREC score 17 points) 7 years after the operation for chronic sinusitis, was re-operated. Four months after the surgery for ECRS, the patient developed fever, cough, and sensory impairment in the lower limbs. Clinical and laboratory examinations at this time confirmed the diagnosis of EGPA. Postoperative histopathology revealed findings of chronic sinusitis at the first surgery and ECRS at the second surgery, with no evidence of vasculitis detected at either examination. It is noteworthy that the patient developed bronchial asthma during the interval between the initial surgery and the onset of ECRS.
Conclusion: ECRS and asthma frequently co-exist, and EGPA is extremely rare. It is difficult to distinguish the prodromal phase of EGPA from ECRS in the absence of systemic symptoms caused by vasculitits, with the patient manifesting only nasal sympoms, asthma, and eosionphilia. In our patient reported herein, the eosinophil count was found to be significantly increased to 22.2% prior to the the second surgery. In patients with ECRS with a differential eosinophil count exceeding 20%, even in the absence of systemic symptoms, it might be necessary to bear in mind the possibility of EGPA.
