PMC10025129_01
(A) No obvious abnormal shadows found in both lungs. (B) Mucus plugs and atelectasis found in the lower lobe of the right lung. (C) No abnormal findings were found.
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As shown in Fig. 1C, no abnormal findings were noted in the brain.
PMC10025129_02
(A) Significant mucus retention observed in the paranasal sinuses, including the ethmoid sinus. (B) Nasal polyps and mild mucosal redness in the middle nasal meatus on both sides. (C1.2) Significant eosinophil infiltration observed in the nasal polyps. No necrotizing vasculitis or granulomas observed.
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As shown in Fig. 2, a large number of eosinophil infiltrations were found in the mucosal tissue, and the patient was diagnosed with eosinophil sinusitis.
PMC10025129_03
(A) No obvious abnormal shadows found in both lungs. (B) Mucus plugs and atelectasis found in the lower lobe of the right lung. (C) No abnormal findings were found.
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As shown in Fig. 1C, no abnormal findings were noted in the brain.
(A) No ulcers, only non-specific inflammation in the large intestine. (B) Few eosinophils infiltrate the large intestine tissue after high-dose steroid administration.
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The examination was performed after initiating steroid treatment; therefore, no abnormal findings were found, as shown in Fig. 3, and biopsy tissue of the large intestine was collected at random.
PMC10025129_04
(A) Free air was observed in the abdominal cavity. (B) Free air, ileal perforation, and peritonitis were observed. (C) Free air was observed around the ileum. (D) A 2-cm perforation was observed opposite the ileal mesentery.
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The doctor on duty conducted an immediate CT scan, which revealed free air around the ileum, as shown in Fig. 4, indicating perforation of the small intestine.
PMC10025129_05
Clinical course of drug treatment. After steroid administration, the eosinophil count decreased rapidly. The onset of bowel perforation occurred on Day 12 of hospitalization. Intravenous immunoglobulin (IVIG) therapy was performed on Day 32 to improve severe neurological symptoms. Mepolizumab was initiated on Day 43 which was continued regularly every 4-5 weeks. The eosinophil count remained around 100/muL even after discharge, and the steroid dose was gradually decreased to 3 mg/day.. MPZ, mepolizumab; IVIG, intravenous high-dose immunoglobulin therapy; PSL, prednisolone; mPSL, methylprednisolone pulse therapy.
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As shown in Fig. 5, 19 months had elapsed since the onset of EGPA; the steroid dose was 3 mg/day, but the eosinophil count remained at 100/muL.