title: Catastrophic subarachnoid hemorrhage in eosinophilic granulomatosis with polyangiitis without asthma.
abstract: Eosinophilic granulomatosis with polyangiitis (EGPA) is characterized by eosinophilic vasculitis. Patients rarely present without asthma. Cases developing subarachnoid hemorrhage from central nervous system vasculitis are rarely reported. We report a 48-year-old woman with rapidly evolving and progressive multi-system eosinophilic vasculitis in the absence of asthma. Tissue eosinophilia was apparent in a breast lump biopsy. Prior otitis media and prominent lymphoid tissue in the postnasal spaces hinted at otolaryngological disease. She had rapid disease progression with mononeuritis multiplex and eventually succumbed to complications of intracranial hemorrhage secondary to central nervous system vasculitis. This case demonstrates the diagnostic dilemma and treatment considerations in EGPA without asthma. It also raises the question if a reliable biomarker can aid diagnosis in atypical presentations of disease.
authors.affiliation: Internal Medicine Residency, Singapore city, Singapore.
authors.forename: Matilda X W
authors.initials: MXW
authors.lastname: Lee
authors.affiliation: Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore city, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore city, Singapore.
authors.forename: Gim Gee
authors.initials: GG
authors.lastname: Teng
authors.affiliation: Department of Pathology, National University Health System, Singapore city, Singapore.
authors.forename: Gangaraju Changal
authors.initials: GC
authors.lastname: Raju
authors.affiliation: Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore city, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore city, Singapore.
authors.forename: Anita Y N
authors.initials: AYN
authors.lastname: Lim
mesh_terms: D001706:Biopsy; D002533:Cerebral Angiography; D015267:Churg-Strauss Syndrome / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D007166:Immunosuppressive Agents
keywords: breast mass; eosinophilic granulomatosis with polyangiitis; subarachnoid hemorrhage