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Eosinophilic granulomatosis with polyangiitis — SCE Respiratory MCQ

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HardInterstitial lung diseaseEosinophilic granulomatosis with polyangiitisSCE Respiratory

A 41-year-old man with adult-onset asthma has sinusitis, weight loss and mononeuritis multiplex. Chest CT shows transient patchy infiltrates, blood eosinophils are 5.2 × 10^9/L and ANCA is positive with MPO specificity. Urinalysis shows microscopic haematuria and mild proteinuria. He has not travelled recently and stool ova testing is negative. What is the most likely diagnosis?

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Correct answer: B — Eosinophilic granulomatosis with polyangiitis

Asthma, marked eosinophilia, sinus disease, neuropathy and renal urinary abnormalities point to EGPA. ABPA can cause asthma and eosinophilia, but neuropathy, haematuria and MPO-ANCA suggest vasculitis. Multi-system features are the discriminator in eosinophilic lung disease questions.

Reference: ERS eosinophilic lung disease guidance; BSR vasculitis guidance