Eosinophilic Granulomatosis with Polyangiitis Revealed by Acute Cholecystitis: A Rare Manifestation

Case Report

Austin J Clin Case Rep. 2023; 10(8): 1308.

Eosinophilic Granulomatosis with Polyangiitis Revealed by Acute Cholecystitis: A Rare Manifestation

Yassine Ennaboulsi¹*; Salah Eddine E¹ Khader1; Mehdi El Aissate¹; Amine Kessab²; Mohammed Karim Moudden¹; Ali Zinebi¹

¹Department of Internal Medicine, Moulay Ismail Military Hospital, Boulevard El Hanssali, Meknes, Morocco

²Department of Pathology, Moulay Ismail Military Hospital, boulevard El Hanssali, Meknes, Morocco

*Corresponding author: Yassine Ennaboulsi Department of Internal Medicine, Moulay Ismail Military Hospital, Boulevard El Hanssali, 50000, Meknes, Morocco Te: +212 6 06 59 12 87 Email: ennaboulsiyass@gmail.com

Received: October 18, 2023 Accepted: November 11, 2023 Published: November 18, 2023

Abstract

Acute cholecystitis is a rare disease of eosinophilic granulomatosis with polyangiitis, which is a systemic necrotizing vasculitis affecting small- to medium-sized vessels, associated with blood and tissue eosinophilia and the presence of extravascular granulomas. We report the case of a 53-year-old female patient who presented with acute acalculous cholecystitis who underwent surgery. The diagnosis of eosinophilic granulomatosis with polyangiitis was based on histology of the gallbladder, antineutrophil cytoplasmic antibody positivity and the presence of polyneuropathy. Corticosteroids allowed a favorable clinical outcome with no relapses during follow-up.

Keywords: Eosinophilic granulomatosis with polyangiitis; Acute cholecystitis; Antineutrophil cytoplasmic antibody; Corticosteroid; Pathology

Abbreviations: EGPA: Eosinophilic granulomatosis with polyangiitis, ANCA: Anti-neutrophil cytoplasmic antibodies

Introduction

Eosinophilic Granulomatosis with Polyangiitis (EGPA), formerly known as Churg-Strauss syndrome, is a systemic necrotizing vasculitis affecting small- to medium-sized vessels, associated with blood and tissue eosinophilia and the presence of extravascular granulomas [1]. It is a rare condition with an annual incidence of 0.9 to 2.4 cases per million population [2].

Anti-Neutrophil Cytoplasmic Antibodies (ANCA) are positive in only around 30% of cases, which leads us to believe that this is a heterogeneous disease with two phenotypes depending on the presence or absence of ANCA.

It can affect the peripheral nerves, skin, lungs, kidneys, cardiovascular system and gastrointestinal tract, but acute cholecystitis is a rare disease of EGPA [3], which makes diagnosis difficult.

We report here a rare case of EGPA manifested by acute acalculous cholecystitis.

Case Report

A 53-year-old patient with no significant history of illness had been hospitalized for recurrent fever and occasional epigastric pain for two weeks.

Abdominal examination revealed tenderness over the right hypochondrium and Murphy's sign was positive. Laboratory investigations showed the following results: white blood cell count 17230/mm3 including 15080/mm³ of neutrophils and 240/mm3 of eosinophils, C-Reactive Protein (CRP) of 230.58mg/L, aspartate aminotransferase of 22IU/ L, alanine aminotransferase of 10IU/L, total bilirubin of 4.11mg/L, Gamma-glutamyl transferase of 72IU/L and alkaline phosphatase of 235IU/L.

Abdominal ultrasonography and abdominal computed tomography revealed a parietal thickening of the gallbladder without visible lithiasis (Figure 1A,1B).