Angiolymphoid Hyperplasia with Eosinophilia Diagnosed by an Abnormal Finding on the Superficial Temporal Artery Graft

Abstract

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon vasoproliferative disease. We report a case of ALHE revealed as a graft abnormality during bypass surgery. A 62-year-old man presented with right hemiparesis and dysarthria. He was at high risk of arteriosclerosis due to hypertension, diabetes, and smoking, and had undergone endovascular treatment for peripheral artery disease twice. Magnetic resonance imaging (MRI) at admission revealed ischemic lesions in the left corona radiata and an occlusion in the left middle cerebral artery (MCA). ¹²³I-IMP single-photon emission computed tomography demonstrated a marked decrease of uptake in the left MCA territory, and we planned to perform superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. The parietal branch of the STA had a dissection in the wall, and the main vascular lumen was severely narrowed. We abandoned double bypass and performed single bypass surgery with the frontal branch of the STA. Histopathology of the parietal branch confirmed the diagnosis of ALHE. When planning treatment for a patient with systemic vascular impairment, the possibility of not only arteriosclerotic change but also inflammatory disease must be considered.