Clinical History
The patient is a 62-year-old woman with asthma, GERD, moderate alcohol intake, and hypertension who presents with 4 weeks of weakness, arthralgia, and fatigue. Her family history is significant for breast cancer and alcohol abuse. She has been treated initially with prednisone with only mild improvement. Her lab results show a highest CK of 1582, alkaline phosphatase of 121, CRP of 35.9, and an absolute eosinophilia.
What is the diagnosis? (Reference images below)
Correct Answer: A.) Diagnosis: Eosinophilic vasculitis
Final pathological findings:
- Fibrinoid necrosis of small muscle arteries
- Mural giant cells
- Surrounding eosinophils
Combined with systemic eosinophilia, this is diagnostic for eosinophilic vasculitis.
The most common clinical diagnosis is eosinophilic granulomatosis with polyangiitis (EGPA; previously Churg-Strauss Syndrome).
References:
Chakraborty RK, Aeddula NR. Eosinophilic Granulomatosis With Polyangiitis (Churg-Strauss Syndrome). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
https://www.ncbi.nlm.nih.gov/books/NBK537099/
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