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EGPA — RACP Adult Medicine MCQ

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ModerateRheumatologyEGPARACP Adult Medicine

A 50-year-old man with a history of asthma presents with peripheral eosinophilia (eosinophils 5.2 × 10⁹/L), migratory pulmonary infiltrates, mononeuritis multiplex, and purpura. p-ANCA (anti-MPO) is positive. Tissue biopsy shows necrotising vasculitis with eosinophilic infiltration. What is the most likely diagnosis?

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Correct answer: B — Eosinophilic granulomatosis with polyangiitis

Late-onset severe asthma with peripheral eosinophilia, migratory pulmonary infiltrates, mononeuritis multiplex, and positive p-ANCA with tissue eosinophilic vasculitis is diagnostic of EGPA (formerly Churg-Strauss). The disease progresses through allergic (asthma), eosinophilic (infiltrates), and vasculitic phases. Treatment is glucocorticoids ± mepolizumab or cyclophosphamide.

Reference: EULAR – 2024 – AAV Guidelines; ACR/VF 2021 EGPA