TA that is easily misdiagnosed as asthma, have you ever learned?

Eosinophilic granulomatous with polyangiitis is a type of systemic vasculitis of unknown etiology, mainly involving small and medium-caliber blood vessels, the age of onset varies from 10~70 years old, most patients are 20~40 years old, and the prevalence of men and women is roughly equal
.

Traditional Chinese medicine believes that eosinophilic granulomatous with polyangiitis belongs to the category of traditional Chinese medicine "Mei Nudan", "melon vine entanglement" and "grape plague", and the disease is mostly caused by the internal organs containing heat and internal and wet evil invasion outside, moist heat and scabbing, vein obstruction or tendon and vein stagnation, resulting in blood vein blockage, pulse loss and blood coagulation; It also descends due to wet turbidity, so it tends to occur in the lower limbs
.

What are the manifestations of eosinophilic granulomatous polyangiitis?

01 respiratory system

The respiratory system is the most susceptible, and asthma occurs in 82%~100% of patients;

Rhinitis occurs in 70% of patients with recurrent episodes of sinusitis, paranasal sinusitis, and nasal polyps;

The incidence of infiltrative lesions in the lungs is 72~93%, mostly patchy edge irregularity, diffuse distribution, can also be nodular, generally does not form cavities such as with severe eosinophilic infiltration can cause chronic eosinophilic pneumonia
.

02 heart

Cardiac involvement accounts for 50% of deaths in eosinophilic granulomatosis with polyangiitis, and eosinophilic infiltration and coronary vasculitis can cause pathologies such as acute constrictive pericarditis, heart failure, and mitral valve prolapse
in myocardial infarction.

03 nervous system

66~98% of patients have nervous system damage, hypertension and intracranial vasculitis, caused by cerebral hemorrhage or cerebral infarction is the second common cause
of death of this disease.

The most common cranial neuropathy is ischemic optic neuritis, cranial nerve palsy is rare, and mononeuritis multiplex can develop into symmetric sensorimotor peripheral neuropathy
.

04 skins

Rashes occur in 70% of patients and include erythematous-papular rashes, hemorrhagic rashes, and cutaneous or subcutaneous nodules
.

Eosinophilic granulomatosis with polyangiitis is highly specific and common on the surface of the extensor and flexor muscles of the limbs, especially at the extensor muscles of the elbow and the fingers (toes), and the subcutaneous nodules last for a long time, heal within 2~3 months, and residual scars
.

05 gastrointestinal tract

31% of patients with gastrointestinal involvement, abdominal pain, diarrhea symptoms, a small number of patients blood in the stool, others such as perforation, gastrointestinal obstruction have also been reported, ascites contains a large number of eosinophils, is one of
the characteristic lesions.

06 kidneys

Focal segmental glomerulonephritis occurs in 85% of patients, but most are mild, mainly manifested as microscopic hematuria and/or proteinuria, and less than 10%
develop acute renal failure.

07 joints

Arthritis due to synovial swelling and/or exudation, mainly in the vasculitic phase, can involve joints throughout the body, and manifests as migratory arthralgias
.

08 muscles

Myalgia is common in the vasculitic phase, where gastrocnemius spastic pain is one of the early manifestations of
allergic granulomatous vasculitis.

How is allergic granulomatous vasculitis treated?

01 Western medicine perspective

The treatment of eosinophilic granulomatous with polyangiitis is mainly glucocorticoids, and most patients have a good effect, and the clinical remission rate of hormones alone is 91%.

In the acute stage, multi-organ involvement was given methylprednisolone 1g/d intravenous drip for 3 days; Under normal circumstances, prednisone 40~60mg/d can be used to reduce the dose
after disease control.
For example, patients with poor response to glucocorticoid therapy can add immunosuppressants such as cyclophosphamide or azathioprine
.

02 TCM perspective

In the acute stage, the symptoms are mostly moist heat and fire poison, blood stasis obstruction, and the treatment is mainly to dispel evil spirits; The treatment is to clear heat and dampness, detoxify and cool blood, and activate blood circulation
.

The symptoms in the remission period are mostly qi deficiency and blood stagnation, blood stasis obstruction, and the treatment is to correct and dispel evil spirits, taking into account both specimens; The treatment is to invigorate qi and blood, dissolve stasis and disperse knots
.