SHM Converge Scientific Abstract ePoster Gallery-When Eosinophils Attack: A Rare Pulmonary Manifestation of Eosinophilic Granulomatosis With Polyangitis

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This case report describes eosinophilic granulomatosis with polyangiitis (EGPA), a rare autoimmune vasculitis of small-to-medium vessels, presenting unusually as a pleural effusion and pneumothorax. EGPA typically begins with allergic symptoms such as asthma, rhinitis, and nasal polyps, followed by peripheral eosinophilia and then vasculitic organ involvement. Because pleural effusion is an uncommon initial manifestation, the diagnosis can be difficult to recognize.<br /><br />An 80-year-old man with a history of scalp angiosarcoma, arterial thrombosis on warfarin, and eosinophilic esophagitis was found to have a new right pneumothorax and moderate pleural effusion on pre-biopsy CT imaging. He also had chronic productive cough, intermittent hemoptysis, and significant weight loss. Laboratory studies showed anemia, eosinophilia, elevated inflammatory markers, and high IgE. Imaging revealed cavitary lung lesions and nodules that were new compared with prior scans. Pleural fluid was exudative and strongly eosinophilic, while cytology, cultures, and infectious workup were negative.<br /><br />Because the hydropneumothorax persisted, the patient underwent wedge resection. Pathology showed chronic interstitial inflammation with prominent eosinophilic infiltration, organizing pneumonia, non-caseating granulomas, and intra-alveolar hemorrhage, without malignancy or infection. Although ANCA and other serologies were negative, the combination of peripheral eosinophilia and biopsy-proven extravascular eosinophilic inflammation met 2022 ACR/EULAR criteria for EGPA.<br /><br />The authors emphasize that EGPA can present atypically and that early recognition is critical, as delayed diagnosis may lead to severe complications. They note that the patient likely would have benefited from timely high-dose corticosteroid therapy, but his condition worsened before confirmation of the diagnosis.

Asset Subtitle

Kunal Jain

Meta Tag

Author List Jennifer Mao, Kunal Jain, Mahnoor Khalid, Sameer Shaik, Zaid Aslam

Category Clinical Vignettes

Concept Eosinophilic Granulomatosis with Polyangiitis

Concept Eosinophilia

Concept Extravascular Eosinophilic Inflammation

Concept Disease Progression

Concept Pulmonary Findings

Distinguished Non-Finalist

Presenter Organization Texas Health Resources

Presenting Author Kunal Jain

Track Adult

Keywords

eosinophilic granulomatosis with polyangiitis

EGPA

pleural effusion

pneumothorax

eosinophilia

autoimmune vasculitis

cavitary lung lesions

eosinophilic inflammation

ANCA-negative

corticosteroid therapy

Eosinophilic Granulomatosis with Polyangiitis

Eosinophilia

Extravascular Eosinophilic Inflammation

Disease Progression

Pulmonary Findings