Eosinophilic granulomatosis with polyangiitis — SCE Respiratory MCQ

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HardRare/MiscellaneousEosinophilic granulomatosis with polyangiitisSCE Respiratory

A 45-year-old woman has late-onset asthma, chronic sinusitis, mononeuritis multiplex and pulmonary infiltrates. Eosinophils are 4.8 x 10^9/L and MPO-ANCA is positive. What is the most likely diagnosis?

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Correct answer: B — Eosinophilic granulomatosis with polyangiitis

The best answer is “Eosinophilic granulomatosis with polyangiitis”. The clinical pattern, physiology and imaging described are most consistent with Eosinophilic granulomatosis with polyangiitis. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Allergic rhinitis alone, within a respiratory pathway”, “Idiopathic pulmonary fibrosis, after specialist assessment”, “Pulmonary embolism, with clinical reassessment”, “Simple aspergilloma, within a respiratory pathway”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: BTS/NICE/SIGN asthma guideline NG245: https://www.nice.org.uk/guidance/ng245/chapter/Recommendations