RESUMEN
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of necrotizing small-to-medium vessel vasculitis that can be associated with antineutrophil cytoplasmic antibody (ANCA) positivity, asthma, and eosinophilia. We present the case of a 65-year-old male with a past medical history of asthma who presented to the emergency department with bilateral upper and lower extremity paresthesias, as well as right foot drop, persisting for a two-week duration. His lab work revealed leukocytosis of 20.6 K/uL with 12.36 K/uL of absolute eosinophils as well as elevated inflammatory markers with an erythrocyte sedimentation rate of 32 mm/hr and CRP of 7.3 mg/dL. Both c-ANCA and p-ANCA titers were also elevated at 1:320. An eventual MRI of the entire spine did not reveal any neurologic or anatomic lesions to explain the patient's symptoms. CT imaging was also remarkable for airspace opacities involving the anterior right and bilateral lower posterior lung regions, as well as pansinusitis. A nerve biopsy showed axonopathy as well as evidence of healed vasculitis. Pulse dose steroids were started, which conferred benefits to the patient after other forms of treatment were unsuccessful. Given the rarity of EGPA, we think it is important to add new cases to the literature with a thorough discussion of the steps leading up to how the diagnosis was made.
RESUMEN
Both Gradenigo's syndrome and Vernet syndrome are rare pathologies of the intracranial space; both involve compression of a particular anatomic location in the skull, thus affecting structures nearby or within that space. A patient presenting with one or both of these syndromes should raise concern for malignancy, head trauma, or an intracranial infection. We present a case of a 39-year-old female with three weeks of left-sided ear, face, and neck pain along with difficulty swallowing and reduced vision in the left eye. Magnetic resonance imaging of the brain revealed fullness in the left nasopharyngeal region, raising concern for malignancy or infection. Biopsy of the mass ultimately revealed Epstein-Barr virus positive nasopharyngeal carcinoma, nonkeratinizing undifferentiated type, along with culture data revealing methicillin-resistant Staphylococcus aureus positive left otomastoiditis. She received chemoradiation therapy along with six weeks of antibiotic therapy. A patient presenting with symptoms reflective of a sinus infection unrelieved by antibiotics with concomitant cranial nerve deficits should raise clinical concern for an intracranial pathology rather than a simple case of sinusitis.
RESUMEN
T-cell large granulocyte lymphocytic (TLGL) leukemia is a lymphoproliferative disorder involving clonal expansion of cytotoxic T-cells and subsequent cytopenia, most notably neutropenia, as well as splenomegaly. TLGL leukemia is commonly associated with autoimmune disorders, most commonly rheumatoid arthritis (RA). We present a case of a 54-year-old female with a past medical history of seropositive RA who was lost to follow-up and thus was not on any active treatment for RA for several years. She returned to the clinic with worsening joint pain, swelling, and stiffness involving multiple joints. Screen laboratory work revealed an absolute neutrophil count (ANC) of 0.19 K/uL, indicating severe neutropenia. This finding prompted further workup, for which our patient was ultimately diagnosed with TLGL leukemia. Proper treatment and control of inflammation in RA are important not only to preserve joint function and vitality but also to prevent rare sequela of untreated autoimmune disorders, as was the case in our patient.