Eosinophilic Granulomatosis with Polyangiitis Presenting as Acute Polyneuropathy Mimicking Guillain-Barre Syndrome

Cámara-Lemarroy, Carlos R.; Infante-Valenzuela, Adrián; Villareal-Montemayor, Hector J.; Soto-Rincón, Carlos A.; Davila-Olalde, Javier A.; Villareal-Velazquez, Hector J.

doi:10.1155/2015/981439

Cited by 10 publications

(8 citation statements)

References 11 publications

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“…Recently published comparative and noncomparative studies of GBS outcomes after treatment with TPE and/or IVIG have consisted primarily of case reports or case series from single institutions in developing countries, at which the choice between TPE and IVIG is largely dependent on economic considerations . Given the established equivalence between TPE and IVIG as effective treatments for GBS, it is important to evaluate patient‐ and hospital‐level characteristics that may affect treatment selection.…”

Section: Introductionmentioning

confidence: 99%

Nationwide study of therapeutic plasma exchange vs intravenous immunoglobulin in Guillain‐Barré syndrome

Beydoun

Hossain

et al. 2020

Muscle and Nerve

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Background: We compared outcomes of therapeutic plasma exchange (TPE) vs intravenous immunoglobulin (IVIG) among hospitalized patients diagnosed with Guillain-Barré syndrome (GBS).Methods: In a retrospective cohort study of 6642 records (2637 TPE and 4005 IVIG) from the 2002-2014 Nationwide Inpatient Sample, treatment type was examined as predictor of length of stay, total charges, and in-hospital death, with regression modeling using risk adjustment and propensity scoring to control for confounders.Results: Compared with those receiving IVIG, patients who underwent TPE experienced prolonged hospitalization by approximately 7.5 days, greater hospitalization costs by approximately $46,000, and increased in-hospital death with an odds ratio of 2.78. Results did not change after controlling for confounders through risk adjustment, propensity score adjustment, or matching.Conclusions: TPE may be associated with poorer healthcare utilization outcomes vs IVIG, although confounding by indication could not be ascertained. K E Y W O R D S autoimmunity, Guillain-Barré syndrome, healthcare utilization, immunotherapy, intravenous immunoglobulin, therapeutic plasma exchange 1 | INTRODUCTION According to evidence-based guidelines by the American Academy of Neurology, the two recommended treatment options for severely affected Guillain-Barré syndrome (GBS) patients are therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG). 1,2Both treatments were shown to be effective and superior to conservative treatment for disability recovery. 2 Although TPE was shown to be safe and less expensive when administered by experienced physicians, IVIG is preferred by most physicians because of its ease of administration and lower likelihood of complications. 2,3 Nevertheless, it is estimated that approximately 20% of patients with GBS may have severe disability, and 4-15% may die despite close monitoring and administration of immunotherapeutic treatments, including TPE or IVIG. 2,4 Recently published comparative and noncomparative studies of GBS outcomes after treatment with TPE and/or IVIG have consisted primarily of case reports or case series from single institutions in developing countries, at which the choice between TPE and IVIG is largely dependent on economic considerations. 1-23 Given the established equivalence between TPE and IVIG as effective treatments for GBS, it is important to evaluate patient-and hospital-level characteristics that may affect treatment selection. Also, given the acute nature of GBS and the increased morbidity and mortality risks

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Section: Introductionmentioning

confidence: 99%

Nationwide study of therapeutic plasma exchange vs intravenous immunoglobulin in Guillain‐Barré syndrome

Beydoun

Hossain

et al. 2020

Muscle and Nerve

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“…In 1998, Keven et al [14] reported the next case presented initially with GBS-like neuropathy, later developing ANCA-positive nephrotic syndrome. At least five other cases of EGPA have been mentioned, all with clinic and neurophysiologic studies suggestive of GBS [15][16][17][18]. Antineutrophil cytoplasmic antibody positivity, eosinophilia and treatment failure with intravenous immunoglobulin led to the correct diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Eosinophilic granulomatosis with polyangiitis presenting with acute polyneuropathy resembling Guillain–Barre syndrome

Hamid¹,

Bourazza²

2022

Int J Case Rep Images

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Introduction: Eosinophilic granulomatosis with polyangiitis (EGPA) is defined as a small-and mediumsized artery necrotizing vasculitis associated with asthma, eosinophilia, and extra neurologic granulomatosis (lung, cardiac, kidney, and skin). We report a case of EGPA with Guillain-Barre syndrome (GBS) like presentation.Case Report: A 37-year-old man with a history of asthma was admitted for rapidly progressive symmetric flaccid areflexic tetraparesis, peripheral facial palsy, proprioceptive hypoesthesia, and thigh skin purpuric lesions.Electroneuromyography study revealed demyelinating sensory motor polyneuropathy with secondary axonal loss. Cervical MRI, cerebrospinal fluid study, and paraclinical tests were normal. Complete blood count showed hypereosinophilia and elevated erythrocyte sedimentation. Electrocardiogram and transthoracic echocardiography were normal. Spirometry revealed obstructive syndrome. Chest and paranasal sinus computed tomography (CT) demonstrated ground-glass opacities and severe pansinusitis. Skin biopsy showed necrotizing vasculitis with eosinophils and antineutrophil

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“…2 There are only two case reports available of PA presenting as a DKA ( Table 1 ). Jiang et al 6 reported an apoplectic GH-secreting adenoma with DKA, while Camara-Lemarroy et al 4 reported a nonadenomatous PA with DKA.…”

Section: Discussionmentioning

confidence: 99%

Pituitary Apoplexy Following Severe Diabetic Ketoacidosis, With Two Uncommon Complications of Supraventricular Tachycardia and Acute Limb Ischemia in a Patient with Neglected Pituitary Adenoma and Undiagnosed Diabetes Mellitus: A Rare Clinical Association

et al. 2022

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Pituitary apoplexy (PA) is a clinical emergency arising from acute ischemia or hemorrhage of the pituitary gland. A small subset of pituitary adenomas present with an apoplectic crisis, with common symptoms being headache, nausea/vomiting, visual impairment, ophthalmoplegia, altered sensorium, panhypopituitarism, etc. Though diabetic ketoacidosis (DKA) is an established complication of uncontrolled diabetes mellitus, its association with PA is extremely rare. Likewise, supraventricular tachycardia (SVT) and acute limb ischemia (ALI) have rare, reported association with DKA. We present one such case of rare associations seen in our clinical practice. A 20-year-old woman was brought to our emergency room with headache, breathlessness, and altered sensorium. Clinical and biochemical evaluation revealed SVT, DKA, and right lower limb ALI. On enquiry, patient was found to be diagnosed with pituitary adenoma 2 years ago and lost to follow-up. PA was detected on neuroimaging and confirmed histopathologically. Possibility of PA presenting as DKA and its sequelae exists.

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Eosinophilic Granulomatosis with Polyangiitis Presenting as Acute Polyneuropathy Mimicking Guillain-Barre Syndrome

Cited by 10 publications

References 11 publications

Nationwide study of therapeutic plasma exchange vs intravenous immunoglobulin in Guillain‐Barré syndrome

Nationwide study of therapeutic plasma exchange vs intravenous immunoglobulin in Guillain‐Barré syndrome

Eosinophilic granulomatosis with polyangiitis presenting with acute polyneuropathy resembling Guillain–Barre syndrome

Pituitary Apoplexy Following Severe Diabetic Ketoacidosis, With Two Uncommon Complications of Supraventricular Tachycardia and Acute Limb Ischemia in a Patient with Neglected Pituitary Adenoma and Undiagnosed Diabetes Mellitus: A Rare Clinical Association

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