Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a history of adult-onset asthma, currently poorly controlled despite maintenance therapy. Reports progressive rhinosinusitis, nasal polyposis, and constitutional symptoms including fatigue, weight loss, and night sweats. Neurological review positive for symptoms of mononeuritis multiplex (distal paresthesia, weakness). No history of cardiac chest pain or palpitations.
Clinical Examination Findings
General: Patient appears chronically ill, no acute distress. HEENT: Nasal polyps noted, mucosal edema. Pulmonary: Bilateral diffuse wheezing, decreased air entry at bases. Cardiovascular: Regular rate and rhythm, no murmurs or S3/S4. Abdominal: Soft, non-tender, no organomegaly. Neurological: Distal sensory deficits in lower extremities, asymmetric motor weakness consistent with mononeuritis multiplex. Skin: Palpable purpura or subcutaneous nodules noted on lower extremities.
Treatment Protocol
Initiate high-dose systemic corticosteroids (prednisone 1mg/kg/day) to induce remission. Consider steroid-sparing agents (cyclophosphamide for severe organ involvement or azathioprine/methotrexate for maintenance). Biologic therapy (mepolizumab) indicated for refractory eosinophilic inflammation. Monitor CBC with differential for peripheral eosinophilia, ESR/CRP for inflammatory markers, and renal function.