Clinical case of eosinophilic granulomatosis with polyangiitis

The article presents a clinical case of an elderly female patient with atypical manifestation of eosinophilic granulomatosis with polyangiitis (EGPA), which was diagnosed only during pathomorphological examination. Using this case as an example, the authors analyse the characteristics of the disease course, the range of clinical symptoms, and the difficulties in diagnosing this pathology. EGPA is a rare form of systemic vasculitis that affects small and medium-sized vessels and is associated with ANCA antibodies (anti-neutrophil cytoplasmic antibodies). EGPA is characterised by the presence of bronchial asthma, eosinophilia, and necrotising granulomatous inflammation with involvement of the respiratory tract and other organs. The pathology has a low prevalence of approximately 10—14 cases per 1 million population, which leads to insufficient awareness among clinicians and increases the risk of diagnostic errors. The course of the disease goes through several successive phases — prodromal (allergic), eosinophilic, and vasculitic — which cause variability in clinical manifestations and significant difficulties in the diagnostic stage. The range of clinical manifestations is multifaceted and varies from bronchial asthma and chronic rhinosinusitis to systemic lesions of the heart, skin, nervous system, kidneys, and gastrointestinal tract. The clinical case described highlights the importance of timely recognition of EGPA symptoms in patients with allergic diseases and frequent respiratory tract inflammation, illustrates the complexity of recognising EGPA in real clinical practice, and emphasises the need for a multidisciplinary approach to the diagnosis and treatment of patients with suspected systemic vasculitis. At the same time, it emphasises the advisability and critical importance of early ante-mortem biopsy for morphological confirmation of the diagnosis, which is key to the timely initiation of immunosuppressive therapy capable of preventing severe systemic complications and fatal outcomes.