1st Case Progression
The patient has now been hospitalized for seven days. Despite receiving
antibiotics, steroids and inhaled bronchodilator, there is only a
partial clinical improvement. The patient still has repeated fever
spikes, requires oxygen therapy and suffers from intense night sweating.
Repeated CBC reveals persistent leukocytosis (25.0 × 10⁹/L) and new
onset of eosinophilia (26%, reference value: < 7%), CRP
value of 58 mg/L with negative hemocultures, negative cultures from
sputum, urine and rectum swabs.
In addition, vesiculopapular skin lesions begin to appear on the
patient’s right arm and left cheek (Fig. 2a), however, both locations
were previously in contact with a fixation tape (i.v. catheter and
oxygen mask). Initially, the lesions appeared as red indurations, which
eventually developed a white tip and coalesced. The dermatologist orders
swabs of the lesion for various infectious etiologies (aerobic and
anaerobic bacteria, viral and fungal pathogens), which are altogether
negative, topical antibacterial treatment with Fusidic acid and
corticosteroid cream was applied. In parallel, the result of PCR from
the sputum sample came back positive for Aspergillus species antigen; however, both the Aspergillus antigen in serum and the
sputum culture for Aspergillus were negative. In addition, a
rheumatology consultation was requested to assess a possible vasculitis,
as marked eosinophilia, vesiculopapular skin lesions, and respiratory
insufficiency might be the symptoms of Eosinophilic Granulomatosis with
Polyangiitis (EGPA). Due to these new findings and the alarming clinical
state of the patient, a chest computed tomography (CT) scan was
indicated, which showed an extensive interstitial lung process with
marked mediastinal lymphadenopathy (Fig. 2b).