#5207 CENTRAL NERVOUS SYSTEM INVOLVEMENT IN EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS: A DIAGNOSTIC DILEMMA

Abstract Background Central nervous system involvement is extremely rare in eosinophilic granulomatosis with polyangiitis, and associated very poor prognosis. A high index of suspicion needed to diagnose this entity initiate prompt treatment for life-threatening condition. Case presentation 71-year-old man was admitted our hospital lower limb weakness, loss vision the left eye diplopia four weeks. Four months prior admission he reported unintentional weight wheezing. Laboratory studies revealed anemia, eosinophilia antineutrophil cytoplasmic antibodies (ANCA) anti myeloperoxidase (MPO) levels. Brain computerized tomography (CT) normal. Although corticosteroids were started, addition other immunosupressants delayed due ongoing infection. During next three days, patient presented worsening kidney function disoriented, agitated combative. Lumbar puncture brain CT scan showed no acute abnormalities. Therefore, plasmapheresis started. third session plasmapheresis, became drowsy non-responsive. subdural hematoma uncal herniation. Trepanation initiation hemodialysis required. Kidney biopsy focal proliferative glomerulonephritis fibrocellular crescents. Magnetic resonance imaging ophthalmological evaluation abnormalities compatible vasculitic disease. Cyclophosphamide added prednisolone, renal extra manifestations improvement. One year later, autonomous, right hand paresis, stable (serum creatinine 2.5 mg/dL) negative ANCA MPO serology. Conclusion Neurological GEPA heterogeneous requires differential diagnosis central infections, adverse effects complication plasmapheresis. The challenging demands a level suspicion. Otherwise, it may lead delayed, erroneous worse survival.