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Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) is a small- to medium-vessel vasculitis associated with asthma and eosinophilia. If left untreated, it can lead to systemic complications with a high mortality rate. The authors present a case of eosinophilic granulomatosis with polyangiitis that initially presented with adult-onset asthma, asymmetric neuropathy to the right lower extremity, and erythematous maculopapular cutaneous lesions to bilateral lower extremities. Through an extensive work-up, the diagnosis of eosinophilic granulomatosis with polyangiitis was made. Steroid therapy was initiated, causing his eosinophil count to return to normal and his presenting symptoms to improve, although his neuropathy and weakness remained. It is our hope that presenting this unusual condition manifesting in the lower extremity can provide guidance to clinicians who might encounter this condition and help them to recognize and treat it before severe chronic complications can manifest.

The superficial fibular (peroneal) nerve traditionally courses through the anterolateral deep leg and pierces the deep crural fascia at the lower leg to divide into its terminal branches. Entrapment of the superficial fibular nerve is most commonly documented to occur at where it pierces the deep fascia, and numerous etiologies causing entrapment are described. In this case report, we describe an unusual cause of entrapment from a tertiary branch of the superficial fibular nerve taking a circumflex course and wrapping around the secondary branch of the main nerve. This was successfully treated by surgical excision. To the best of our knowledge, this cause of entrapment has not been described in the literature at the time of this publication.