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61-year old man with bilateral lower extremity weakness and a T6 sensory level. Neuroimaging showed multiple ring enhancing lesions in the brain and a single lesion in the thoracic spinal cord. The patient also had peripheral eosinophilia.
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) is a vasculitis of small and medium sized arteries. Lung, skin, and peripheral nerves are most commonly affected but it may involve the cardiovascular, gastrointestinal, renal, and central nervous systems. CNS involvement occurs in approximately 7% of cases and typically presents as infarct or hemorrhage. Microscopically, blood vessels show an eosinophil-rich inflammatory infiltrate in the vessel wall, often with fibrinoid necrosis. Granulomas are occasionally seen. Treatment is generally with steroids and other immunosuppressive agents.