What question did this study set out to answer?

The aim is to differentiate between eosinophilic granulomatosis with polyangiitis and chronic eosinophilic pneumonia due to overlapping symptoms.

May 20, 2026

B35-10 Overlapping Eosinophilic Lung Disease: Chronic Eosinophilic Pneumonia Unmasking Eosinophilic Granulomatosis With Polyangiitis

Key Points

The aim is to differentiate between eosinophilic granulomatosis with polyangiitis and chronic eosinophilic pneumonia due to overlapping symptoms.
Case report of a 45-year-old man with asthma, chronic eosinophilia, and respiratory symptoms.
Diagnostic assessments included high-resolution CT and bronchoalveolar lavage showing eosinophilic presence.
Treatment involved intravenous steroids and subsequent initiation of mepolizumab.
EGPA diagnosed with ACR criteria: asthma, eosinophilia >10%, infiltrates, neuropathy, ANCA positive.
Initial treatment with IV methylprednisolone led to symptom resolution; pulse steroids were needed due to rebound eosinophilia.
At 3 months post-treatment with mepolizumab, the patient remained asymptomatic on a reduced steroid dosage.

Abstract

Abstract Background Eosinophilic granulomatosis with polyangiitis (EGPA), formerly Churg-Strauss syndrome, is a rare ANCA-associated vasculitis featuring adult-onset asthma, eosinophilia, and multisystem vasculitis. It often overlaps with chronic eosinophilic pneumonia (CEP), a Th2-driven, lung-limited disorder (3% of interstitial lung diseases) with eosinophilic alveolar infiltration, female predominance (2:1), and asthma in 60-75% of cases. Differentiation is vital: EGPA requires immunosuppression to prevent organ damage, while CEP is steroid-responsive. Case A 45-year-old man with adult-onset asthma, chronic eosinophilia, GERD, and post-cholesteatoma hearing loss presented with dyspnea, wheezing, near-syncope, productive cough, hemoptysis, night sweats, weight loss, myalgias, and arm heaviness. Exam showed fever (38.3 °C), tachycardia (110 bpm), 94% SpO2, and bilateral wheezes. Travel history included recent international trips; medications: omeprazole, prednisone (5 mg), budesonide-formoterol, ketoprofen. Labs: leukocytosis (13,750/µL) with 77% eosinophils (10.62 × 10³/µL), elevated IgE (307 IU/mL), CRP (35 mg/L), ESR (54 mm/hr), MPO-ANCA ≥149 U (p-ANCA+). HRCT: bilateral lower-lobe opacities, tree-in-bud nodularity, centrilobular nodules in ground-glass, favoring EGPA over CEP’s typical peripheral consolidations. Infectious workup negative. BAL: 49% eosinophils; biopsies: eosinophil-rich inflammation without vasculitis. Diagnosis: EGPA (ACR criteria met: asthma, eosinophilia 10%, infiltrates, neuropathy, ANCA+). Treatment: IV methylprednisolone (40 mg daily) resolved pulmonary symptoms; rebound eosinophilia prompted pulse steroids (1 g ×3). Discharged on prednisone taper; post-discharge small bowel obstruction (EGPA-related) resolved conservatively. Mepolizumab (300 mg SC monthly) initiated; at 3 months, asymptomatic on 5 mg prednisone. Discussion This case highlights EGPA-CEP overlap, with initial CEP-like features (subacute symptoms, BAL eosinophils) masking systemic vasculitis. Clues to EGPA: ANCA+, extrapulmonary involvement (neuropathy, GI), centrilobular nodules. EGPA phases (allergic/eosinophilic/vasculitic) risk cardiac/GI complications untreated. Steroids induced remission; mepolizumab enabled tapering per MIRRA trial (higher remission, fewer relapses). Conclusion EGPA may mimic CEP, delaying diagnosis. ANCA testing, systemic assessment, and imaging aid differentiation. Biologics like mepolizumab offer steroid-sparing control, improving outcomes. This abstract is funded by: none

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Cite This Study

Ogaryan et al. (Fri,) studied this question.

synapsesocial.com/papers/6a0d4f92f03e14405aa9adda https://doi.org/https://doi.org/10.1093/ajrccm/aamag162.492

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