Acute aortoiliac thrombosis and mitral valve regurgitation as acute onset of eosinophilic granulomatosis with polyangiitis in a 26-year-old patient

We present a rare case of Eosinophilic Granulomatosis with Polyangiitis (EGPA), involving a 26-year-old woman with a history of asthma and nasal polyps. The patient presented with acute aorto-iliac thrombosis and mitral insufficiency, successfully treated with thrombolysis, aortic thromboendarterectomy and valve replacement. Peripheral hypereosinophilia with eosinophilic infiltration of the heart led to the diagnosis of ANCA-negative EGPA. Treatment with prednisone and Mepolizumab was started, resulting in a positive outcome. This case showcases an unusual manifestation of EGPA with large sized vessel involvement, needing surgical and pharmacological treatment; it highlights the importance of early detection for timely intervention and improved prognosis.