The symptoms of mononeuritis associated with eosinophilic granulomatosis with polyangiitis (EGPA) resemble those of radiculopathy associated with spinal diseases. Herein, we report three cases of neuropathy caused by EGPA, which were suspected of spinal diseases.
Case 1 : A 71-year-old woman had a chief complaint of back pain and numbness in both lower limbs. Imaging examination showed L4 and L5 spondylolysis and nerve root stenosis of the intervertebral foramen, and posterior lumbar interbody fusion (PLIF) was scheduled. However, preoperative blood test results revealed a white blood cell count of 37,800 (eosinophils : 76%). The patient was referred to the Department of Neurology at another hospital, where she was diagnosed with EGPA and treated with steroid pulse therapy.
Case 2 : A 38-year-old woman presented with a chief complaint of numbness and pain in the right upper extremity and weakness in the right lower extremity. Cervical spine magnetic resonance imaging (MRI) showed mild intervertebral foramen stenosis. She was placed under observation with medication. However, her right lower extremity weakness rapidly progressed. Since Guillain-Barré syndrome was suspected, the patient was referred to the Department of Neurology for further management. A blood test revealed 30,500 white blood cells (eosinophils : 80%), which led to the diagnosis of EGPA.
Case 3 : A 56-year-old man had a chief complaint of pain in both perineal regions and numbness in the right forearm. Lumbar MRI revealed a suspected arachnoid cyst. A blood test showed 31,000 white blood cells (eosinophils : 74.6%). Therefore, the patient was referred to the Department of Collagen Disease due to suspicion of EGPA.
All three patients had a history of bronchial asthma.
EGPA is a type of anti-neutrophil cytoplasmic antibody (ANCA) -associated vasculitis formerly called Churg-Strauss syndrome. Symptoms are preceded by asthma and allergic rhinitis and followed by polyangiitis mononeuritis with a high frequency of numbness, pain, and weakness in the extremities. Patients are often referred to spine surgeons on suspicion of spinal disease. However, focusing solely on imaging findings may delay patient's opportunity for early treatment and result in residual neurological deficits. Since early diagnosis and treatment are important, EGPA is one of the important diseases that spine surgeons should be aware of.
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