Eosinophilic granulomatosis with polyangiitis — SCE Rheumatology MCQ

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ModerateVasculitisEosinophilic granulomatosis with polyangiitisSCE Rheumatology

A 46-year-old woman with adult-onset asthma develops sinusitis, mononeuritis multiplex and palpable purpura. Eosinophils are 5.2 × 10⁹/L and MPO-ANCA is positive. Chest CT shows migratory pulmonary infiltrates. Urinalysis shows trace blood. What is the most likely diagnosis?

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Correct answer: A — Eosinophilic granulomatosis with polyangiitis

Explanation lettering: C = shown as A · D = shown as B · B = shown as C · A = shown as D

Eosinophilic granulomatosis with polyangiitis is best because asthma, eosinophilia, neuropathy, purpura and migratory infiltrates are characteristic of EGPA. A is less suitable because GPA usually has granulomatous ENT disease without marked eosinophilia or asthma; B is less suitable because hypersensitivity pneumonitis would not cause mononeuritis multiplex and purpura; D is less suitable because SLE does not produce this eosinophilic asthma-vasculitis phenotype; E is less suitable because PAN affects medium vessels and is not associated with ANCA glomerulonephritis/asthma. Clinical pearl: EGPA may be ANCA-positive or ANCA-negative; asthma and eosinophilia are central clues.

Reference: EULAR AAV recommendations 2022; BSR ANCA-associated vasculitis recommendations 2025