CTICasesEosinophilic Granulomatosis with Polyangiitis (EGPA) with Pulmonary Hemorrhage
Imaging findings
A patient with rapidly worsening respiratory distress over several days has progressively denser, cloud-like bilateral upper-lung opacities on radiograph; CT shows patchy, centrally and peribronchial-predominant consolidation. The patient develops hemoptysis, and bronchoscopy confirms pulmonary hemorrhage; new purpuric skin lesions subsequently develop and are biopsied.
Key takeaways
Pulmonary hemorrhage together with new eosinophilic skin lesions establishes a diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA/Churg-Strauss), a vasculitis that should be considered when eosinophilic lung disease is accompanied by extrapulmonary organ involvement such as skin lesions initially mistaken for a fungal process.
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