August 2025 Medical Image of the Month: Crazy Paving in a Case of Eosinophilic Granulomatosis with Polyangiitis

By: Wengler JC, Jokerst C

Abstract: 

No abstract available. Manuscript truncated after 150 words. A 73-year-old woman with a history of eosinophilic granulomatosis with polyangiitis (EGPA), and heart failure with preserved ejection fraction presented to the hospital with acute pancreatitis and developed acute (on-chronic) hypoxic respiratory failure during treatment. Her previous EGPA complications included interstitial lung disease (ILD) as well as GI, skin, and cardiac involvement. She was being treated with rituximab and mepolizumab at the time of admission. However, this treatment had not improved her skin rashes, late-onset asthma, or arthralgias.

At admission, the patient was on a baseline of 3L oxygen, which worsened to 7-12L upon beginning IV fluids. The patients' labs were pertinent for B-type natriuretic peptide (BNP) 9378 pg/ml (normal <100pg/ml, increased from _~2000 2-months prior), lipase 702 U/L (normal , 0-160) and an absolute eosinophil count of 390cells/µL  (normal 0-500). The transthoracic echocardiogram results were unchanged from four months prior, and diuresis failed to improve oxygen needs, raising the …

URL: https://www.swjpcc.com/imaging/2025/8/2/august-2025-medical-image-of-the-month-crazy-paving-in-a-cas.html