Time Line
Jan 13,2019 Right knee join pain .Treated as “reactive arthritis”
July 13,2019 Admitted with acute abdominal pain. Diagnosed as
appendicitis and undergone appendectomy.
July 14,2019 Detected o have hypertension.
July 23,2019 Admitted with bilateral, asymmetrical, spastic paraparesis
and was diagnosed o have transverse myelitis .Stared on IV
methyl prednisolone pulse therapy followed by prednisolone
1mg /kg.
Aug 05, 2019 Initial flaccid quadriparesis, later progressed o ascending
spastic quadriplegia with a sensory level, bulbar
involvement, Examination revealed a transient purpuric rash
around ankle
Aug 06,2019 1.MRI Pan spine MRI brain showed ischemia of medulla
oblongata, spinal cord and multiple infarctions of various
ages in both cerebral hemispheres and the brain ,probably
secondary vasculitis.

2. Histology report of appendicular biopsy showed appendix
   with evidence of small vessel eosinophilic vasculitis and
   eosinophilic necrotic granuloma which was suggestive of
   EGPA
3. ANA, C- ANCA, P- ANCA was sent. (Which came
   negative later.).Initial FBC on admission didn’t’ show hyper
   eosinophilia though noted in a FBC done previously.
   Aug 06, 2019 Stared on IV methylprednisolone and cyclophosphamide
   pulse therapy with rheumatology opinion.
   Aug 10,2019 Bulbar weakness resolved and upper limb power stared to
   improve.