A 36-year-old woman with adult-onset asthma and chronic nasal congestion presents with a right foot drop and patchy sensory loss in the left arm. Total leucocyte count is 19,000/uL with 32% mature eosinophils. Chest CT shows fleeting migratory infiltrates. ANCA testing by ELISA shows antimyeloperoxidase specificity. Cardiac function is normal. What is the most likely diagnosis?
- A Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) ✓
- B Granulomatosis with polyangiitis
- C Microscopic polyangiitis
- D Hypereosinophilic syndrome with neuropathy
Correct answer: A. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
Explanation
The triad of asthma and allergic rhinitis, marked peripheral blood eosinophilia, and vasculitic neuropathy defines eosinophilic granulomatosis with polyangiitis. Roughly 40% of patients are MPO-ANCA positive; those who are ANCA positive tend toward small-vessel vasculitic manifestations such as neuropathy and glomerulonephritis. GPA typically causes granulomatous sinus disease and cavitating lung lesions without eosinophilia, while hypereosinophilic syndrome causes endomyocardial fibrosis rather than vasculitis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.