A 45-year-old male patient presented with complaints of fever and myalgias for 7 days duration, parasthesias and weakness of both hands and feet for 4 days, cough and breathlessness and wheeze for 4 days duration. He had difficulty in holding objects with the hands and difficulty in walking. He had history of sinusitis in the past underwent sinus surgery seven years and then two years back. He was a known asthmatic on intermittent inhaler use since five years. He had history of exacerbation of asthma one month back, treated with Methylprednisolone, Monteleukast, IV antibiotics and other supportive measures. He had no history of Diabetis mellitus, Hypertension, coronary artery disease in the past. His general examination was unremarkable. Pulse rate was 108/minutes, respiratory rate 28/minutes and blood pressure was 120/70 mm Hg. Respiratory system examination revealed bilateral expiratory Ronchi. Nervous system examination revealed bilateral asymmetrical distal muscle weakness with sensory loss. Deep Tendon Reflexes were not elicitable in both upper and lower limbs, except the Biceps reflexes. Other system examination were normal. Investigations revealed hemoglobin 11.7 gm/dl, total Leukocyte count 21,700 cells/mm3, (Neutrophils 64%, Lymphocytes 15%, Monocytes 1% and Eosinophils 20%) [Table/Fig-1], platelet count 3.0 lakhs/mm3, ESR 70 mm and absolute eosinophil count was 4000cells/mm3. Renal function tests were normal but had mild Hepatopathy. Creatinine phosphokinase was 532U/L (normal upto 200 U/L) CPK-MB is normal, Troponin T-test was negative. There was sinus tachycardia in Electrocardiogram but Echocardiogram showed hypokinesia in septum and anterior wall. Coronary angiogram showed mild single vessel disease in Left anterior descending coronary artery territory. Chest radiograph was normal. There were no ova and cysts in stools. Smear for microfilaria was negative. ANA, anti dsDNA and c-ANCA were negative
