Gastrointestinal involvement as the initial presentation of eosinophilic granulomatosis with polyangiitis: a rare case report

Eosinophilic granulomatosis with polyangiitis (EGPA) is one of the antineutrophils cytoplasmic antibodies (ANCA)-associated vasculitis syndromes which is characterized by extravascular necrotizing granulomas formation, peripheral blood eosinophilia, and extensive tissue infiltration by eosinophils. 30–40% of EGPA patients had positive perinuclear antineutrophilic cytoplasmic antibodies P- ANCA serology; they frequently presented with vasculitis features, e.g., neuropathy, glomerulonephritis, and purpura, whereas ANCA negative patients more frequently presented with pulmonary involvement and cardiomyopathy. We present a case of 36 years old, male patient who presented with atypical presentation of EGPA in form of perforated viscus, followed by sensorimotor polyneuropathy of both Upper and lower limbs. Histopathological evidence of resected bowel showed evidence of small and medium-sized vasculitis with excessive eosinophilic infiltration and granuloma formation. Induction remission by Steroids and Intravenous cyclophosphamide showed a dramatic response in relieving patient’s symptoms. EGPA, ANCA, Blood eosinophilia, vasculitis, Intestinal perforation.