Presentation
Worsened cough and shortness of breath. History of eosinophilic granulomatosis with polyangiitis (EGPA) treated with azathioprine and prednisone, and emphysema due to heavy smoking.
Patient Data
Patchy infiltrates with prominent interstitial markings in the upper and lower zones of the right lung and all three zones of the left lung.
Hiatus hernia.
Bronchial wall thickening and cylindrical bronchiectasis, probably due to longstanding COPD and asthma (the latter is present in virtually all EGPA patients).
Ground glass opacity with thickened intralobular septae in the left lung apex; similar lingular opacity; smaller but similar paramediastinal opacity in the right upper lobe. None were present on a CT chest scan done 6 months prior (not shown).
No axillary, mediastinal or hilar lymphadenopathy.
Moderate-sized hiatal hernia.
Case Discussion
Fleeting pulmonary infiltrates are a classical sign of EGPA (Churg-Strauss syndrome).
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