Tehran University of Medical Sciences Immunology and Genetics Journal 2645-4831 4 2 2021 06 22 124 131 Fatemeh Sadat Mahdavi Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran Elahe Dolatshahi Department of Rheumatology, Clinical Research Development Unit Shahid Rajaei, Alborz University of Medical Sciences, Karaj, Iran Saeideh Tabesh Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 2021 09 11 2022 01 29 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. https://igj.tums.ac.ir/index.php/igj/article/view/86 https://igj.tums.ac.ir/index.php/igj/article/download/86/76