Pulmonary Embolism Revealing an Eosinophilic Granulomatosis with Polyangiitis: A Case Report.

Abstract

Introduction: Venous thromboembolism presents a rare clinical manifestation of Eosinophilic Granulomatosis with polyangiitis.

Case presentation: We present a case of pulmonary embolism associated with Eosinophilic Granulomatosis with Polyangiitis (EGPA) systemic manifestations in a 26-year-old Tunisian female patient. She presented with dyspnea and blood hypereosinophilia. Blood tests revealed elevated D-dimer levels. Lung scintigraphy (V/Q-scan) revealed pulmonary artery embolism in the right lung. The Computed Tomography (CT) image showed circumferential wall thickness of the lower mediastinal oesophagus and gastroesophageal junction. The chest scan also showed multiple pulmonary infiltrates with a ground-glass appearance localized in the apex of the posterior segment of the right upper lobe. The CT scan of the sinuses showed circumferential thickening of the maxillary sinus. Based on the 2022 ACR/EULAR diagnosis criteria, the patient was diagnosed with Eosinophilic Granulomatosis with Polyangiitis. After one month of anti-vitamin K treatment, a spirometry showed an obstructive pattern. The patient underwent methylprednisolone pulses, followed by oral corticosteroids, which were slowly tapered concomitantly with a cyclophosphamide regimen. A marked improvement of the spirometry parameters was achieved.

Conclusions: Clinicians should be vigilant in the diagnostic and therapeutic management of Pulmonary Embolism (PE) during the active phase of EGPA to establish adequate follow-up procedures.