J Neurol Res

Journal of Neurology Research, ISSN 1923-2845 print, 1923-2853 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Neurol Res and Elmer Press Inc

Journal website https://jnr.elmerpub.com

Case Report

Volume 000, Number 000, October 2026, pages 000-000

Eosinophilic Granulomatosis With Polyangiitis Misdiagnosed as Hyper-Eosinophilic Syndrome: A Case Report

↓ **Table 1.** Hematological Biochemical Profile of Patient
Investigation	Patient result	Normal range
ESR: erythrocyte sedimentation rate; SGPT: serum glutamic pyruvic transaminase; RBS: random blood glucose; CRP: C-reactive protein.
Hemoglobin	13 g/dL	13–17 g/dL
Platelets	650,000/mm³	150,000–450,000/mm³
Total leucocytes	27,310/mm³	4,000–10,000/mm³
Neutrophils	19.9%	40–80%
Lymphocytes	10.9%	20–40%
Eosinophils	65.1%	1–6%
Absolute eosinophil count	17.8 × 10⁹/L	< 0.5 × 10⁹/L
Monocytes	3.5%	2–10%
Basophils	0.6%	< 1%
Reticulocyte count	1%	0.5–2%
ESR	60 mm/1st h	0–15 mm/1st h
Serum creatinine	0.7 mg/dL	0.6–1.2 mg/dL
Sodium	140 mmol/L	135–150 mmol/L
Potassium	3.77 mmol/L	3.5–5.1 mmol/L
Chloride	106 mmol/L	96–112 mmol/L
Serum bilirubin	0.3 mg/dL	0.1–1.0 mg/dL
SGPT	11 U/L	10–50 U/L
Alkaline phosphatase	102 U/L	40–129 U/L
RBS	82 mg/dL	70–140 mg/dL
CRP	< 0.4 mg/dL	< 1.0 mg/dL

↓ Table 1. Hematological Biochemical Profile of Patient

Investigation

Patient result

Normal range

ESR: erythrocyte sedimentation rate; SGPT: serum glutamic pyruvic transaminase; RBS: random blood glucose; CRP: C-reactive protein.

Hemoglobin

13 g/dL

13–17 g/dL

Platelets

650,000/mm³

150,000–450,000/mm³

Total leucocytes

27,310/mm³

4,000–10,000/mm³

Neutrophils

19.9%

40–80%

Lymphocytes

10.9%

20–40%

Eosinophils

65.1%

1–6%

Absolute eosinophil count

17.8 × 10⁹/L

< 0.5 × 10⁹/L

Monocytes

3.5%

2–10%

Basophils

0.6%

< 1%

Reticulocyte count

0.5–2%

ESR

60 mm/1st h

0–15 mm/1st h

Serum creatinine

0.7 mg/dL

0.6–1.2 mg/dL

Sodium

140 mmol/L

135–150 mmol/L

Potassium

3.77 mmol/L

3.5–5.1 mmol/L

Chloride

106 mmol/L

96–112 mmol/L

Serum bilirubin

0.3 mg/dL

0.1–1.0 mg/dL

SGPT

11 U/L

10–50 U/L

Alkaline phosphatase

102 U/L

40–129 U/L

RBS

82 mg/dL

70–140 mg/dL

CRP

< 0.4 mg/dL

< 1.0 mg/dL

↓ **Table 2.** Investigations for Secondary Causes of Eosinophilia and Organ Involvement
Investigation category	Investigation	Patient finding
COVID-19: coronavirus disease 2019; HBsAg: hepatitis B virus antigen; HCV: hepatitis C virus; HIV: human immunodeficiency virus; p-ANCA/MPO-ANCA: perinuclear-staining antineutrophil cytoplasmic antibody/myeloperoxidase-antineutrophil cytoplasmic antibody; ECG: electrocardiogram; NT-proBNP: N-terminal pro-brain natriuretic peptide; LVEF: left ventricular ejection fraction.
Infectious and parasitic evaluation	Stool routine examination	Normal
	Stool ova and parasites examination (three serial samples)	Negative for helminthic ova, protozoal cysts, and rhabditiform larvae
	Thick and thin blood film	Negative for Plasmodium species and microfilariae
	Blood culture	No growth
	Urine culture	No growth
	COVID-19 antigen	Negative
	HBsAg	Non-reactive
	Anti-HCV	Non-reactive
	HIV	Negative
Autoimmune and systemic evaluation	Antinuclear antibody	Negative
	p-ANCA/MPO-ANCA	Positive (100 AU)
	Urinalysis	Normal; no proteinuria, pus cells, or casts
	Ultrasound abdomen and pelvis	Normal
Cardiac evaluation	12-lead ECG	Normal sinus rhythm; no significant ST-T or conduction abnormalities
	Transthoracic echocardiography	LVEF 62%; no regional wall-motion abnormality, intracardiac thrombus, apical obliteration, or pericardial effusion
	High-sensitivity troponin I	4.8 ng/L (normal < 14 ng/L)
	NT-proBNP	68 pg/mL (normal < 125 pg/mL)

↓ Table 2. Investigations for Secondary Causes of Eosinophilia and Organ Involvement

Investigation category

Investigation

Patient finding

COVID-19: coronavirus disease 2019; HBsAg: hepatitis B virus antigen; HCV: hepatitis C virus; HIV: human immunodeficiency virus; p-ANCA/MPO-ANCA: perinuclear-staining antineutrophil cytoplasmic antibody/myeloperoxidase-antineutrophil cytoplasmic antibody; ECG: electrocardiogram; NT-proBNP: N-terminal pro-brain natriuretic peptide; LVEF: left ventricular ejection fraction.

Infectious and parasitic evaluation

Stool routine examination

Normal

Stool ova and parasites examination (three serial samples)

Negative for helminthic ova, protozoal cysts, and rhabditiform larvae

Thick and thin blood film

Negative for Plasmodium species and microfilariae

Blood culture

No growth

Urine culture

No growth

COVID-19 antigen

Negative

HBsAg

Non-reactive

Anti-HCV

Non-reactive

HIV

Negative

Autoimmune and systemic evaluation

Antinuclear antibody

Negative

p-ANCA/MPO-ANCA

Positive (100 AU)

Urinalysis

Normal; no proteinuria, pus cells, or casts

Ultrasound abdomen and pelvis

Normal

Cardiac evaluation

12-lead ECG

Normal sinus rhythm; no significant ST-T or conduction abnormalities

Transthoracic echocardiography

LVEF 62%; no regional wall-motion abnormality, intracardiac thrombus, apical obliteration, or pericardial effusion

High-sensitivity troponin I

4.8 ng/L (normal < 14 ng/L)

NT-proBNP

68 pg/mL (normal < 125 pg/mL)

↓ **Table 3.** The 2022 ACR/EULAR Classification Criteria for Eosinophilic Granulomatosis With Polyangiitis
Criterion category	Criterion item	Weight (points)	Patient presentation	Points assigned
Classification rule: After exclusion of mimics of vasculitis and in a patient with an established diagnosis of small- or medium-vessel vasculitis, a cumulative score ≥ 6 supports classification as EGPA. Sensitivity: 85%, specificity: 99%. ACR/EULAR: American College of Rheumatology and European Alliance of Associations for Rheumatology; ANCA: antineutrophil cytoplasmic antibody; EGPA: eosinophilic granulomatosis with polyangiitis.
Clinical criteria	Obstructive airway disease (e.g., asthma)	+3	Documented adult-onset asthma	+3
	Nasal polyps	+3	Not documented	0
	Mono-neuritis multiplex or motor neuropathy (not due to radiculopathy)	+1	Severe motor-predominant axonal polyneuropathy; bilateral foot drop	+1
Laboratory and biopsy criteria	Blood eosinophil count ≥ 1 × 10⁹/L	+5	Peak eosinophils: 17.8 × 10⁹/L (65.1% of 27,310/µL)	+5
	Extravascular eosinophilic-predominant inflammation on biopsy	+2	Not performed (skin/nerve biopsy not performed)	0
	Cytoplasmic ANCA or anti-proteinase 3 (PR3)-ANCA positivity	−3	PR3-ANCA negative	0
	Hematuria	−1	Absent; urinalysis normal	0
Total score				+9

↓ Table 3. The 2022 ACR/EULAR Classification Criteria for Eosinophilic Granulomatosis With Polyangiitis

Criterion category

Criterion item

Weight (points)

Patient presentation

Points assigned

Classification rule: After exclusion of mimics of vasculitis and in a patient with an established diagnosis of small- or medium-vessel vasculitis, a cumulative score ≥ 6 supports classification as EGPA. Sensitivity: 85%, specificity: 99%. ACR/EULAR: American College of Rheumatology and European Alliance of Associations for Rheumatology; ANCA: antineutrophil cytoplasmic antibody; EGPA: eosinophilic granulomatosis with polyangiitis.

Clinical criteria

Obstructive airway disease (e.g., asthma)

Documented adult-onset asthma

Nasal polyps

Not documented

Mono-neuritis multiplex or motor neuropathy (not due to radiculopathy)

Severe motor-predominant axonal polyneuropathy; bilateral foot drop

Laboratory and biopsy criteria

Blood eosinophil count ≥ 1 × 10⁹/L

Peak eosinophils: 17.8 × 10⁹/L (65.1% of 27,310/µL)

Extravascular eosinophilic-predominant inflammation on biopsy

Not performed (skin/nerve biopsy not performed)

Cytoplasmic ANCA or anti-proteinase 3 (PR3)-ANCA positivity

−3

PR3-ANCA negative

Hematuria

−1

Absent; urinalysis normal

Total score