[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-407875-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-407875-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","eosinophilic-granulomatosis-with-polyangiitis-presenting-as-a-mononeuritis-multiplex-mimicking-guillain-barre-syndrome","Eosinophilic Granulomatosis With Polyangiitis Presenting as a Mononeuritis Multiplex Mimicking Guillain-Barré Syndrome","","A 41-year-old Malay woman with allergic rhinitis, nasal polyps, and eczema developed bilateral foot numbness and weakness, with bilateral foot drop and sensory loss in the L5-S1 dermatomes. Nerve conduction studies demonstrated bilateral peroneal and tibial axonal neuropathy, initially leading to Guillain-Barré syndrome and treatment with IVIG, without clinical improvement. CT showed pansinusitis, exam showed vasculitic rashes, labs revealed marked eosinophilia and positive p-ANCA, revising the diagnosis to EGPA with mononeuritis multiplex. Corticosteroids and methotrexate produced significant neurological improvement with no relapse.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/eosinophilic-granulomatosis-with-polyangiitis-presenting-as-a-mononeuritis-multiplex-mimicking-guillain-barre-syndrome/407875/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/eosinophilic-granulomatosis-with-polyangiitis-presenting-as-a-mononeuritis-multiplex-mimicking-guillain-barre-syndrome/407875.png","ImageObject",300,407,{"name":42,"@type":43},"McQueen","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-02","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",13,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why was the patient initially diagnosed with Guillain-Barré syndrome (GBS)?","Question",{"text":63,"@type":64},"She presented with acute bilateral foot weakness, sensory loss in L5-S1 dermatomes, and nerve conduction studies showing axonal neuropathy, which can overlap with GBS. She was therefore treated with IVIG initially.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What findings led to revising the diagnosis to EGPA with mononeuritis multiplex?",{"text":68,"@type":64},"Further evaluation showed pansinusitis on CT, vasculitic rashes, marked eosinophilia (8.7 × 10⁹/L), and positive p-ANCA, supporting EGPA rather than GBS.",{"name":70,"@type":61,"acceptedAnswer":71},"What treatment resulted in improvement, and was there relapse during follow-up?",{"text":72,"@type":64},"Corticosteroid therapy with methotrexate led to significant neurological improvement. 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This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98202  \nOpen Access Case Report  \nEosinophilic Granulomatosis With Polyangiitis Presenting as a Mononeuritis Multiplex Mimicking Guillain-Barré Syndrome  \nMohamad Zikir Ismail 1, Fathin Hadi 1, Wan Syamimee Wan Ghazali 1, Bazli Md Yusoff 2  \n1. Internal Medicine, Universiti Sains Malaysia, Kubang Kerian, MYS 2. Radiology, Hospital Universiti Sains Malaysia, Kota Bharu, MYS  \nCorresponding author: Fathin Hadi, [fathinhadi@usm.my](fathinhadi@usm.my)  \nAbstract  \nA 41-year-old Malay woman with a background of allergic rhinitis, nasal polyps, and eczema presented with bilateral foot numbness and weakness. Neurological examination revealed bilateral foot drop and sensory loss over the L5-S1 dermatomes. Nerve conduction studies showed bilateral peroneal and tibial axonalneuropathy. She was initially diagnosed with Guillain-Barré syndrome (GBS) and treated with intravenous immunoglobulin (IVIG), but showed no clinical improvement. Further evaluation revealed pansinusitis on CT imaging, vasculitic rashes, marked eosinophilia of 8.7 × 10⁹/L, and positive p-ANCA (1: 160), leading to a revised diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA) with mononeuritis multiplex. She responded well to corticosteroid therapy and methotrexate, with significant neurological improvement and no relapse observed at follow-up. This case highlights the diagnostic challenge of distinguishing EGPA from GBS in patients with acute neuropathy and highlights the importance of recognizing systemic features such as asthma, eosinophilia, and vasculitic signs to guide appropriate immunosuppressive treatment.  \nCategories: Neurology, Radiology, Rheumatology  \nKeywords: eosinophilic granulomatosis with polyangiitis (egpa), guillain-barre syndrome (gbs), mononeuritis multiplex, p-anti-neutrophil cytoplasmic antibodies (p-anca), vasculitis  \nIntroduction  \nMononeuritis multiplex is a common neurological manifestation of eosinophilic granulomatosis with polyangiitis (EGPA), also known as Churg-Strauss syndrome [1] . Meanwhile, the peripheral nervous system involvement observed in Guillain-Barré Syndrome (GBS), characterised by mixed axonal and demyelinating neuropathy affecting both sensory and motor nerves, can overlap with the neuropathic manifestations seen in EGPA [2] . In clinical practice, patients who initially present with acute bilateral limb weakness andareflexia may be misdiagnosed as having GBS. However, the subsequent appearance of systemic features such as asthma, sinusitis, eosinophilia, or ANCA positivity should prompt reconsideration of EGPA as the underlying cause [2,3] . Differentiating between EGPA and GBS, therefore, requires a dynamic diagnostic approach that integrates neurological, haematological, and systemic findings.  \nCase Presentation  \nWe present the case of a 41-year-old Malay woman with a history of allergic rhinitis, nasal polyps, and chronic eczema. She presented with bilateral foot numbness and difficulty walking for two weeks.  \nNeurological examination showed bilateral foot drop (3/5 strength) with impaired dorsiflexion, eversion, and inversion. Sensory loss was noted in the bilateral L5 and S 1 dermatomes, and ankle reflexes were diminished, while knee reflexes remained intact. Gait analysis revealed a steppage gait. Further examination revealed maculopapular rashes on both lower limbs (Figures 1, 2) . She was referred to dermatology for further evaluation, and the rashes were thought to represent vasculitis. A skin biopsy was planned, but the patient declined. A non-contrast CT scan of the brain showed no significant intracranial abnormaliti","cbCaivGA1f4pQ0Po","https://ap.wps.com/l/cbCaivGA1f4pQ0Po","pdf",3237465,"English","# Abstract\n# Introduction\n# Case Presentation\n## Nerve/Site (Table 1)","[{\"question\":\"Why was the patient initially diagnosed with Guillain-Barré syndrome (GBS)?\",\"answer\":\"She presented with acute bilateral foot weakness, sensory loss in L5-S1 dermatomes, and nerve conduction studies showing axonal neuropathy, which can overlap with GBS. She was therefore treated with IVIG initially.\"},{\"question\":\"What findings led to revising the diagnosis to EGPA with mononeuritis multiplex?\",\"answer\":\"Further evaluation showed pansinusitis on CT, vasculitic rashes, marked eosinophilia (8.7 × 10⁹/L), and positive p-ANCA, supporting EGPA rather than GBS.\"},{\"question\":\"What treatment resulted in improvement, and was there relapse during follow-up?\",\"answer\":\"Corticosteroid therapy with methotrexate led to significant neurological improvement. Follow-up reported no relapse.\"}]","Eosinophilic Granulomatosis With Polyangiitis Presenting as a Mononeuritis Multiplex Mimicking Guillain-Barré Syndrome | PDF",1790576700,23]