Bilateral diaphragmatic paralysis as clinical onset of Eosinophilic Granulomatosis with Polyangiitis: a case report

Eosinophilic Granulomatosis with Polyangiitis (EGPA) is a rare small-vessel vasculitis which may affect different organs, leading to a highly variable and often challenging initial clinical presentation. We report the case of a 67-year-old man presenting with acute non-exertional dyspnea and chest tightness. He had an history of adult-onset asthma, chronic rhinosinusitis and peripheral eosinophilia. Imaging revealed bilateral diaphragmatic elevation, and needle electromyography confirmed diaphragmatic paralysis. The combination of his history and the presence of eosinophilic exudative pleural effusion, transient pulmonary ground-glass opacities and turbinate eosinophilic extravascular inflammation, led us to diagnose EGPA characterized by bilateral diaphragm paralysis. EGPA should be considered in patients with unexplained diaphragmatic paralysis associated with appropriate clinical and laboratory picture, as prompt recognition is crucial for the prognosis.