Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

A case report of effective intravenous immunoglobulin for lower limbs pain in steroid-resistant eosinophilic granulomatosis with polyangiitis

Masashi Tsuchida, M.D.1), Takao Fukushima, M.D., Ph.D.1), Kunihiko Makino, M.D.1), Hiroshi Miida, M.D., Ph.D.2) and Takeo Kuwabara, M.D., Ph.D.1)

1)Department of Neurology, Niigata Preferctural Shibata Hospital
2)Department of Dermatology, Niigata Preferctural Shibata Hospital

We report a 58-year-old woman with bronchial asthma. The onset of the disease was marked by numbness in the right lower extremity, for which she was hospitalized 10 days later. The patient presented with sensory impairment and muscle weakness in the distal regions of both lower limbs, acute pain, purpura, and a leukocyte count of 2.4 ~ 104l(59.2% eosinophils). Nerve conduction tests revealed a decrease in the amplitude of the compound muscle action potential in all 4 extremities. Skin biopsy results led to the diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA). Steroid pulse therapy and oral steroid therapy were initiated but did not resolve the acute pain or numbness. However, intravenous immunoglobulin (IVIg) was administered at day 28 after the beginning of the steroid treatment, and the pain started to improve immediately afterward. In some cases, IVIg can be effective in the treatment of intense pain in peripheral neuropathy associated with steroid-resistant EGPA.
Full Text of this Article in Japanese PDF (7112K)

(CLINICA NEUROL, 54: 231|233, 2014)
key words: eosinophilic granulomatosis with polyangiitis (EGPA), steroid-resistant, intravenous immunoglobulin (IVIg), allergic granulomatous angitis (AGA), Churg-Strauss syndrome (CSS)

(Received: 12-Apr-13)