Case Report

Hepatic Involvement in Eosinophilic Granulomatosis with Polyangiitis


We presented a case report of Eosinophilic Granulomatosis with Polyangiitis (EGPA) with hepatic involvement which presented itself as multiple nodules in the liver. This confirmed Hprevious literature results, which have reported hepatic involvement in EGPA. The results of the study showed a 45-year-old female with asthma, presented with polyarthralgia, hypostasis in both hands and skin lesions on the body. Lab tests revealed elevated Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP). The total Leukocyte count was 11900 (/ul) with 22% Eosinophil. Computed Tomography (CT) scan of both lungs and liver showed multiple irregular nodules. In the biopsy of the skin lesions, Eosinophilic Vasculitis was reported. Electromyography and Nerve Conduction Velocity (EMG-NCV) was compatible to C8-T11 radiculopathy and Axonal Sensory Motor Polyneuropathy. According to the tests and biopsies the patient was diagnosed with EGPA. Although EGPA is characterized by asthma, hypereosinophilia and vasculitis, it can be presented with atypical manifestations as well.

1. Churg J, Strauss L. Allergic granulomatosis, allergic angiitis, and periarteritis nodosa. Am J Pathol. 1951;27(2):277.
2. Noth I, Strek ME, Leff AR. Churg-strauss syndrome. The Lancet. 2003;361(9357):587-94.
3. Baldini C, Talarico R, Della Rossa A, Bombardieri S. Clinical manifestations and treatment of Churg-Strauss syndrome. Rheum Dis Clin N Am. 2010;36(3):527-43.
4. Piram M, Maldini C, Mahr A. Effect of race/ethnicity on risk, presentation and course of connective tissue diseases and primary systemic vasculitides. Curr Opin Rheumatol. 2012;24(2):193-200.
5. Masi AT, Hunder GG, Lie JT, Michel BA, Bloch DA, Arend WP, et al. The American College of Rheumatology 1990 criteria for the classification of Churg‐Strauss syndrome (allergic granulomatosis and angiitis). Arthritis Rheum. 1990;33(8):1094-100.
6. Otani Y, Anzai S, Shibuya H, Fujiwara S, Takayasu S, Asada Y, et al. Churg‐Strauss Syndrome (CSS) Manifested as Necrosis of Fingers and Toes and Liver Infarction. J Dermatol. 2003;30(11):810-5.
7. Harada M, Oe S, Shibata M, Taguchi M, Matsuhashi T, Hiura M, et al. Churg–Strauss syndrome manifesting as cholestasis and diagnosed by liver biopsy. Hepatol Res. 2012;42(9):940-4.
8. Vaglio A, Buzio C, Zwerina J. Eosinophilic granulomatosis with polyangiitis (Churg–Strauss): state of the art. Allergy. 2013;68(3):261-73.
9. Oh M-J, Lee J-Y, Kwon N-H, Choi D-C. Churg-Strauss syndrome: the clinical features and long-term follow-up of 17 patients. J Korean Med Sci. 2006;21(2):265-71.
10. Chen K-R, Carlson JA. Clinical approach to cutaneous vasculitis. Am J Clin Dermatol. 2008;9(2):71-92.
11. Sironen R, Seppä A, Kosma V, Kuopio T. Churg–Strauss syndrome manifested by appendicitis, cholecystitis and superficial micronodular liver lesions—an unusual clinicopathological presentation. J Clin Rheumatol. 2010;63(9):848-50.
12. Suzuki M, Nabeshima K, Miyazaki M, Yoshimura H, Tagawa S, Shiraki K. Churg-Strauss syndrome complicated by colon erosion, acalculous cholecystitis and liver abscesses. World J Gastroenterol. 2005;11(33):5248.
13. Matsui K, Nishijima K. A case of montelukast-Induced Churg-Strauss syndrome associated with liver dysfunction. Case Reports Hepatols. 2011;2011.
14. Qian J, Tong H, Chen F, Mai W, Lou Y, Jin J. A case report for fatal Churg-Strauss syndrome complications: first reported death due to rapid progression of prominently huge hepatic capsular hematoma and multi-system organ hemorrhage. Int J Clin Exp Med. 2014;7(10):3703.
IssueVol 4, No 2 (2021) QRcode
SectionCase Report
Churg-Strauss Syndrome Eosinophilic Granulomatosis with Polyangiitis Hepatic Involvement Multiple Nodules

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Mahdavi FS, Dolatshahi E, Tabesh S. Hepatic Involvement in Eosinophilic Granulomatosis with Polyangiitis. Immunol Genet J. 2021;4(2):124-131.