Late-Presenting Eosinophilic Granulomatosis with Polyangiitis as Cause of Pulmonary Fibrosis: A Case-Based Review

Mediterr J Rheumatol. 2024 Feb 12;35(1):172-178. doi: 10.31138/mjr.161023.lpe. eCollection 2024 Mar.

Abstract

Introduction: Eosinophilic granulomatosis with polyangiitis (eGPA) is a necrotising vasculitis of small and medium calibre vessels, which affects mostly patients in their fourth to sixth decade of life, and it is a very uncommon aetiology for pulmonary fibrosis.

Clinical case: A Hispanic 72-year-old female patient presents with a history of lower extremities pain, paraesthesia, oedema, and occasional macroscopic haematuria. During her hospitalisation, the patient presents, and images showed findings compatible with pulmonary fibrosis and alveolar haemorrhage, which require a biopsy, establishing the diagnosis of an eGPA.

Discussion: eGPA is a low-incidence autoimmune vasculitis, with a high number of phenotypes which explain the broad clinical spectrum, but recent advances has helped to understand the physiopathology and its link with other conditions like pulmonary fibrosis.

Conclusion: Early diagnosis and management of this condition is mandatory because it is the only factor that change the outcome of the patients.

Keywords: ANCA-associated vasculitis; eosinophilic granulomatous vasculitis; interstitial pneumonia; pulmonary fibrosis.