Eosinophilia with Granulomatosis and Polyangiitis in a 57-Year Old Man with Worsening Muscle Pain

Eosinophilia with granulomatosis and polyangiitis (EGPA, previously called Churg-Strauss syndrome or allergic granulomatosis and angiitis) is an anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis affecting small-sized vessels, which typically occurs in patients with a history of allergic rhinitis or asthma. The most serious cases arise from the involvement of other organ systems, notably the cardiovascular system. Importantly, patients may first exhibit non-specific manifestations such as malaise, fever, anorexia, and weight loss. This variable presentation and the potential for multi-organ involvement can lengthen time to diagnosis and delay treatment. We describe a patient who presented with progressive myalgias on the background of recently diagnosed rhinosinusitis who was ultimately diagnosed with EGPA. This case is meant to alert general internists to the diagnostic challenges of EGPA.